It seems the issue of the proper route of administration of PPN has reared it's ugly head again--I have tried explaining the concept of high osmalarity (in this case 872 printed right on the bag) and it's insult on peripheral vasculature (the patient had Phlebitis in two previous sights) but in the latest incident the Pharmacy told the nurse it was OK to give PPN via PIV (Nurses and I guess Pharmacists too still think PPN stands for Peripheral Nutrition when in fact it represents Partial Parenteral Nutrition)--In a few weeks I will be attending a system wide IV forum and I would like to present definitive information to the group in order to finally get PPN via PIV eliminated from the hospital medication administration policy--Ammunition should be in the form of references please--Thank you Â
Cheryl Kelley RN BSN, VA-BC
Robbin George RN VA-BC
You might try developing a "nursing policy" with the INS standards regarding which line to place and when. That way, it will certainly get the attention of all parties when the two policies conflict, thus opening the door for pharmacy and nursing to begin this important discussion.
WE did this when IR wanted us to try PICC's on patient's with nonfucntion fistuala, grafts, etc. WE did not feel we should do this patient, so we created a nrusing based PICC policy that stated "that patient's with X, Y, and Z should have a direct referral to IR." Guess what? It worked......
Cheryl Kelley RN BSN, VA-BC
Can you track how long a peripheral IV lasts with PPN? In my experience, the peripheral IVs don't last more than 12 hours. The patient has pain at the site and cannot tolerate the high osmolarity effects on their vein.
Can you consult with a nutritionist about the actual benefit of PPN? It is less than optimal for providing the nutrition that the patients need. (Again, this is my experience.)
Gwen Irwin
Austin, Texas