flushing after lipids have infused
Hi I had a question regarding TPN. When TPN and Lipids are hung separately and the lipids are completed after 12 hours, and the TPN continues to hang, should the cap (maxplus) that the lipids were infusing into, be flushed with NS? Some say to backflush with the TPN solution, to prevent opening the system, but TPN is basically dextrose so would this not be an infection risk to leave a cap filled with TPN? Would it be best to flush the cap with NS after the completion of the lipids? Thanks for your input.
I am not sure I understand your question. Are you infusing the IVFE through a separate lumen or through a Y-site on the same set as the PN?
If through a separate lumen, it would always require flushing the same as any other fluid that has been infused and is now stopped.
If through a Y-site on the PN administration set, you should consider changing the set if it has been exposed to IVFE and not use that set beyond 24 hours. IVFE grows fungi very easily, so this is why you must change the IVFE set q 24 hours. The question has always been about the short segment of set that exposed to IVFE when it is piggybacked into the Y-site. If it is not changed at 24 hours, I would definitely flush it with saline and would not backflush with the PN solution. Glucose should never be allowed to remain inside a locked lumen or set as it will easily provide nutrients for biofilm to grown. INS standards addresses both of these issues. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks for your reply and I apologize my question was not as clear as it could have been. Yes I am speaking of the Y set and the lipids infusing only 12 hours whereas the TPN is continuous My question is when the nurse takes down the lipids piggyback should she flush the cap (we use maxplus) 1. with NS or 2. should she keep the system closed and backprime with the TPN or 3. just disconnect the IVPB and not flush the cap at all? There is a difference of opinion on this and wanted to get clarification of the correct way to do this. Thanks so much for your advice.
Backpriming with the PN solution will not provide any benefit. How often are you changing the entire PN administration set? Any set that has been exposed to IVFE should be changed every 24 hours, however if there is no IVFE a PN set can remain iin use for 72 hours. If you choose not to change the set every 24 hours and there has been IVFE piggybacked, I would flush with saline. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you for your reply, yes we are infusing lipids into a Y set, piggybacking them into the primary, and we yes change the TPN primary tubing set q24hrs. But my question is; do we need to, or should we flush the maxplus cap that is on the cassett tubing that the 12hour lipids had been infusing into? The cap remains on the tubing cassett after the lipids are complete and I was concerned about the lipids sitting in this cap. (We use Hospira Plum pump and tubings) Thank you for your help.
Hi Lynn, would you please look at the additional question regarding lipids from 8/10? I value your opinion, thank you, Lori.
YOu will need to be more specific, thought we had discussed all questions, no time to read all posts again. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Our hospital uses Max-Plus Clear and when disconnecting the lipids that are connected below the filter of the primary freamine tubing we flush the connector with 10ml NSS. My thought is even though we change our freamine tubing every 24 hours, I do not want the lipid solution hanging out in that y-site connector.
That was my thought exactly but just wanted another opinion, thanks so much!