We are trying to find out some information re: TPN. It seems that most of our PICC infections come from patients with TPN infusing. We have looked at things like dedicated line if the line was new etc. We are just looking to see if anyone out there does anything different when a pt is going to recieve TPN? Thanks.
We too have seen this problem and I have recently thought about including a teaching sheet on the RAND for those pts receiving TPN through a CVC. The average nurse out there administering TPN and Lipids does not realize the increased potential for infection that these pts face (or at least where I work). I always suggest that they do not use the line for blood draws or at the minimum that lumen. Next all tubing is changed every 24 hours. 99% of our pts are getting their TPN through PICC lines now. On rare occasions we will star tit in a CVC that is 4-6 days old until we can place the PICC the next day. Lastly, we wear a mask with our sterile dressing changes and cap changes and we also put on the biopatch immediately after insertion. We also pitched a fit about our nursing staff being careless about scrubbing ports and looping tubing and have seen improvements. Only the PICC nurses change the PICC dressing as well.
I would go further than merely "suggesting" that they do not use a TPN line for other meds and blood draws. I would make it part of the policy. Giving other meds through the line where TPN is infusing is asking for compatibility problems along with infection. That is why we need multiple lumen catheters in these patients - one for the TPN and one for the meds. Also, if your TPN has lipids admixed or piggybacked, the tubing must be changed every 24 hours. However if there is no lipids it should be changed every 72 hours - CDC and INS. Frequent tubing changes increased hub manipulation and increases infection risk. I would also require a direct hub to hub connection and eliminate the needleless connector in these lines and make it a policy that these lines can not be disconnected for any reason.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
I agree that TPN should be infused through a dedicated line and no other medications should be piggybacked into it period! There are those instances where a patient may have a picc line for several days prior to the start of TPN, I do not think that the line needs to be replaced in this instance (as one physician suggested to me) because if the catheter has been flushed as ordered, there should be no complication with starting TPN in one of the lumens and then dedicating it to that. I also agree that only PICC nurses are good at dressing changes, but I challenge us to come up with a solution to this problem. I have tried many different education techniques, none of which seem to work. although primary CRBSI in my facility (for picc lines only) is very low with none in the past 6 months and less than 1.4% prior to that (we place about 120 lines per month), those that do result in a positive were greater than 48hrs after placement and most likely related to catheter manipulation, care and maintenance.