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SANDRA OCONNELL
EXISTING LINES FOR TPN

HOPE SOMEONE CAN ANSWER THIS ONE FOR ME;

IF A PT HAS AN EXISTING CENTRAL LINE, CAN IT BE USED FOR TPN, WITHOUT INCREASING THE INFECTION RISK?

Wendy Erickson RN
Are you asking if a new line
Are you asking if a new line needs to be placed?  I would say "No".  We would go ahead and use the current access that is available.  At that point, a lumen should be dedicated to the TPN and lipids.  If the line is a central venous catheter (not a PICC), a PICC would eventually be placed, probably sooner rather than later as we do not like to leave CVC's in place for very long.  But we have no problem using what is in place, including Hickmans and ports.

Wendy Erickson RN
Eau Claire WI

lynncrni
I agree. The concept of the

I agree. The concept of the so-called "virgin" line for TPN is not found in the guidelines from any organization and I have never even found an article stating an opinion that this is necessary. So use what you have already in place but from that point on, it must be dedicated to nothing but TPN/lipids.  

 

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

Kathleen
My understanding is if the
My understanding is if the line has not been used for a blood product then it can be used for tpn. I believe I saw this in a cdc/AVA article. This is in our Tpn /nutrition policy.
lynncrni
I don't recall anything

I don't recall anything stating that. Can you give use the reference? Thanks 

 

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

Halle Utter
So, I have a question.  If

So, I have a question.  If you have a homecare patient with a single lumen tunneled catheter for TPN, ends up with a UTI or cellulitis, requiring IV antibiotics once or twice daily, and the TPN is given only at night over 12 hours, you would put in a second line, say a PICC, for the antibiotic? 

 

Halle Utter, RN, BSN

Intravenous Care, INc 

Hallene E Utter, RN, BSN Intravenous Care, INC

lynncrni
Not always for the situation

Not always for the situation you described. You have to weigh the risk vs the benefits for each patient. When you routinely piggyback secondary fluids and medications into a TPN line, you have 2 problems - compatibility and infection. When you use the same catheter for sequential infusion as you described, the compatibility issue goes away but you still have the increased hub manipulation which increases the risk of contamination and subsequent infection. It is a case-by-case decision.  

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

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