Forum topic

8 posts / 0 new
Last post
Heather Nichols
TPN and a port

  

     I had a physician today ask me to place a PICC for TPN.  I knew that this particular patient had a port, so I asked what was wrong with the port.  The nurse replied,"nothing".  I asked why it was not being used for TPN.  The nurse replied that the physician said that the port could not be used for TPN because a surgical oncologist she knew said so. 

     I never really got an answer on WHY that was, but I felt like a PICC had more of a chance to get infected, especially with the home health agencies we have around here, and in turn infect the port, than the port itself getting infected by infusing TPN through it.  Does anyone know of a reason that a port cannot be used for TPN.  We place plenty for our elective surgery patients for TPN.  Seems like if this were true, I would have heard of it by now.  Thanks ahead of time for any and all responses.

lynncrni
No valid reason that I can

No valid reason that I can think of. Many patients get ports for TPN, especially if they will be accessing it themselves on a daily basis. Lynn 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Robbin George
If the patient has a single
If the patient has a single Port and requires TPN we will insert a PICC dedicated for TPN so the Port can be used for other incompatiable infusates--I was told several years ago that it was not a good practice to use an implanted Port for TPN for infection control concerns and the risk of comprimising the integrity of what is intended to be a permanent life line

Robbin George RN VA-BC

John Costa
INS Standards of Practice

INS Standards of Practice clearly states in their Parenteral Nutrition section (pg S75, 69, item B) “a central vascular access device with tip placement in the vena cava”. With no differential in the type of central vascular access device to be used.

John Costa, RN

Director of Sales

AccessRN, Inc.

afruitloop
Robyn, Same thing at my

Robyn,

Same thing at my facility.  Our oncologists never wanted TPN thru the patient's port, and we woudl place a PICC also.  They didnt want the high potential for infection with TPN infusing thru the port.

Cheryl Kelley RN BSN, VA-BC

Oncology Ambula...
Our Interventional
Our Interventional Radiologists have never liked using Ports for continuous infusions,particularly TPN. I never really believed them until Dennis Maki presented at our Grand Rounds a few years ago. He, also discouraged using Ports for TPN because of the high dextrose concentrations. It does make sense because of Port design and all that we know about hyperglycemia. It is much easier to remove a PICC than a Port in the presence of infection. Karen

Karen McKeon Williford RN, CRNI

momdogz
Mari Cordes, BS RN  Nurse
Mari Cordes, BS RN 
Nurse Educator IV Therapy
Fletcher Allen Health Care
 
Some of our oncologists will only have single ports placed in their patients and instruct them not to let anyone use it for anything else.  They want to make sure the patient will be able to get chemo for as long as they need it, and feel that they have better control over the maintenance of the port if only a small number of people access/use it - and they are people that they train.
 
Otherwise, yes - we use ports for TPN infusion if it is the best option for the patient. 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Heather Nichols
          Thanks

    

     Thanks everyone for answering, but I am asking for written proof.  Like a study.  I know that TPN has high potential for infection, but it is put thru ports a lot, and I know for fact that a PICC has a higher infection and complication rate than the port, so who is to say the PICC will not become infected and infect the port anyway.  If the patient goes septic, all lines would have to be removed.  It just does not make sense to me to place another source for infection, when the patient already has a perfectly good VAD with lower infection potential already.  Any written proof?

Log in or register to post comments