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Michelle MacArthur
Use of PICC port/multi-lumen port for TPN once used for other fluids

I was wondering if someone could respond to this question.  If a patient has either a multi-lumen central line catheter, or a PICC line which has been used, and then a decision is made to initiate TPN, is there a need to remove the current line and insert a new line before initiating the TPN?

 

Karen Day
Karen Day's picture
I asked a similar question

I asked a similar question to this once before and if I remember correctly the general responses were that if following correct care and maintenance policy and procedures for these lines (flushing with appropriate amount of solutions and in appropriate recommended manners and intervals) that these lines should not have to be replaced in order to initiate TPN, however, once the TPN is initiated, then that particular lumen becomes a dedicated TPN lumen and should be used for nothing else.  Hope this helps.

 

Michelle MacArthur
Hi Karen,   Thank you for

Hi Karen,

 

Thank you for your response. We had an occasion when using a double lumen PICC, when the TPN infusion was hung via the non designated port. In your experience would you automatically have the line changed or would you leave that up to a medical decision?

Michelle 

 

Michelle MacArthur
Hi Karen, Thank you for your

Hi Karen,

Thank you for your response. I am in agreement with your suggestions, but I think the question is worth some discussion. If you have any additional thoughts I would love to hear them.

Thanks.

Michelle

Karen Day
Karen Day's picture
Michelle, are you saying

Michelle,

are you saying that ultimately TPN was infused through both lumens of the catheter and thus you lost your dedicated lumen?  If so, I guess I would speak with the physician and ask his/her opinion.  I do know that TPN is such a rich medium for bacteria and it would warrant close monitoring of the patient for temp and wbc elevations and probably prompt removal at that time, but then you wonder would it be more cost effective to go ahead and change out the line so as not to risk the CRBSI and no payment due to the new rules.  good question, maybe we can get some more input from others here. Sorry I wasn't much help.

 

lynncrni
There is no evidence that an

There is no evidence that an existing CVC should be changed before TPN is started. I am pulling this from my memory, but I think the TPN solutions supports the growth of fungi, not bacteria. I think the pH will not support the growth of bacteria and this is why candidemia is the biggest concern with this solution. Having a dedicated lumen for TPN is for 2 purposes. One is infection control to prevent the tubing manipulations that introduce contaminates into the line. The other is solution compatibility. Many other drugs and solutions are not compatible with TPN and will lead to precipitates or reduce the drugs benefits. 

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

Michelle MacArthur
Lynn,   Thank you for your

Lynn,

 

Thank you for your response.

 

Michelle

daylily
Where can I find evidence

Where can I find evidence that supports dedicating this line?  I've heard it talked about but is there research to support this practice (line would be contaminated).  This would be great to help support a change in practice.

So, if one lumen does not draw blood you would NEVER disconnect the TPN to attempt the draw from that lumen even if the patient cannot be drawn peripherally?  I can see this happening.

lynncrni
Guidelines published by

Guidelines published by ASPEN. 

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

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