What is wrong (if any)with this picture?

Nurses General Nursing

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You come on shift and have a pt with a triple central line. Looking at the IV bags, you see a routine IV bag hanging. Your eyes shift to the TPN and Lipids that are infusing. The Lipids are the primary IV solution. The TPN is piggybacked with the filter above the pump mechanism and then the two run in together to the patient.

Specializes in Acute Care Cardiac, Education, Prof Practice.

Generally on a triple lumen we don't run anything on the middle port. Most patients have a double so we do IVF, meds, PCA's, abx on one port and TPN/lipids on the other. Filter on TPN at the end of the line, closest to the patient, lipids on a separate pump run into the TPN below the filter. Line change on TPN/lipids Q24 at 6pm. Lipids tend to be cyclic 6p-6a so I guess that makes the line changed Q12.

Sounds like a bit of a mess, and I guess you will have to hit up the pharmacy or nurse educator for support/evidence/policy.

Best of luck!!

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Were they each running at the correct rate?

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Specializes in Certified Med/Surg tele, and other stuff.
Were they each running at the correct rate?

Yes they were. That was the only thing that was right.:lol2:

Tait: We have strict policies, why they were ignored was for convenience. Our triples are usually set up like yours with the one port left alone for blood draws. It's not rocket science but this facility can't seem to be consistent about it.

Can we say EDUCATION? (which is what I will be doing on tomorrow at work).

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Specializes in Acute Care Cardiac, Education, Prof Practice.
Yes they were. That was the only thing that was right.:lol2:

Tait: We have strict policies, why they were ignored was for convenience. Our triples are usually set up like yours with the one port left alone for blood draws. It's not rocket science but this facility can't seem to be consistent about it.

Can we say EDUCATION? (which is what I will be doing on tomorrow at work).

Yeah it sounds like education is the problem. Hope you have good luck with your teaching :)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Originally Posted by tokmom viewpost.gif

I have also found PCA's piggy backed into the TPN line.
:rolleyes:
[end quote]

WHAT!!!!!!!!!!!!!!!!!!!!! :smackingf OMG!!!!!!!!!!!!!!!!!!:grn: Unbelievable! We ALL know (or at least we should) that TPN is ALWAYS ALONE......and the ONLY permissible co-infusion are lipids and alumin (in most cases) through a "virgin line" or designated line.
:nono:
If they want evidence based practice tell them to google it or re-take nursing 101......or better yet....call pharmacy and ask them.

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Specializes in ICU, Telemetry.

Having just spent the last shift swimming in a sea of TPN....we don't even have a port above the filter for that to even be possible (Baxter tubing). Maybe that could be a suggestion at your shop? They can't mess up what they can't physically do. And we have standing orders that we run TPN, lipids and Dip together thru the same port, rather than just get a second triple lumen placed....then again, knowing who'd have placed a second triple over the weekend, it was probably safer for the pt NOT to have called the surgeon, since he already had 2 chest tubes....Dr. Wonderful would have popped what little lung my pt had left...:-(

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Having just spent the last shift swimming in a sea of TPN....we don't even have a port above the filter for that to even be possible (Baxter tubing). Maybe that could be a suggestion at your shop? They can't mess up what they can't physically do. And we have standing orders that we run TPN, lipids and Dip together thru the same port, rather than just get a second triple lumen placed....then again, knowing who'd have placed a second triple over the weekend, it was probably safer for the pt NOT to have called the surgeon, since he already had 2 chest tubes....Dr. Wonderful would have popped what little lung my pt had left...:-(

LOL Hear ya on that one !! :)

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Specializes in Med/Surg.
The lipid PB is all I know. I have never seen one with lipids and TPN combined. If this is the case, then is the lipids causing bacterial growth in the tubing, hence it being PB's so low in the tubing, really just an outdated theory?

ETA: We change our lipid tubing Q 12 hrs and our TPN Q 24. I guess we would change the tubing Q 24 with a combined mixture.

Where I worked, lipids and TPN were always and only in the same bag (guess I am grateful for that, reading this thread). Tubing is changed every 24 hours on the bag. Filter is at the bottom of the tubing, close to the port it's infusing in. Nothing else is given through that port.

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I guess I do not see what is wrong with the picture. It is common practice at my facility to have lipids as the primary (since you do not filter lipids) and the TPN piggy back with the filter tubing connected. We never run anything else with the TPN/lipids. Can someone explain to me why this is not correct? It's my facilities policy to do it this way so I would think it is safe?

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Specializes in Med-Surg/Oncology.
I have also found PCA's piggy backed into the TPN line.:rolleyes:

Yikes. :eek: I'm a brand new RN fresh off of orientation, and I know this is something that is never, ever done.

I have never set up TPN/lipids, but I know at my facility the lipids are piggybacked (not the TPN) and the filter is below the pump (close to patient).

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Specializes in M/S, Tele, Sub (stepdown), Hospice.

How about having a PCA pump & then having the TPN on a different pump attached to the PCA tubing (port nearest the patient)...??

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Not something I've ever done....

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