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.
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.
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.
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?
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.
Wendy Erickson RN
Eau Claire WI
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., 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 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., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
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
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., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861