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PLS Help! New with questions about CVL/PICC

Hello everyone I am new in the NICU and have some questions about CVL/PICC.  If anyone could help or direct me to a website I would really appreciate it!  I have spent hours online trying to find a direct answer but I didn't have any luck.

1.  At our facility we have change the TPN/Lipids tubing Q 24H, the way I have been taught is after I have primed my new TPN/L tubing and have it hanging ready to go, I pause the pump on current TPN and channel off the Lipids, and remove the current TPN/L from the pump, place the new TPN/L in the pump, set the rate and start it, then I disconnect the old TPN/L from the patient, clean off the hub and place in the new running TPN/L.  What I don't understand is when I take the old TPN/L out of the pump, I still haven't disconnected this from the patient, doesn't that mean that the old TPN/L is still infusing into the patient and at what rate, since I haven't clamped anything off and the rate is no longer regulated by the pump (and it takes a little time to put in the new tubing in the pump and program in the new rate/TPN and rate/dose/amt for Lipids, Im still new so I am really slow).  I just don't understand this and I cant get an answer from anyone,  I'm really worried that I am doing something wrong!


2.  On a CVL mainly broviacs the process is the same, except that the connector or adapter leg is white and appears different that on a PICC.  When we change the tubing we change everything down to the connector (I think the connector is called the luer lock that attatches to the 3 Lumen TPN/L/Saline filled lumen)  that connects to the white adapter leg.  What worries me is  the same as above, and another concern is I clamp off the CVL when I am taking off the old tubing, then I am to clean the connector with alcohol then attach the new running tpn.lipids, but when I am cleaning with alcohol and the connector is exposed to air, isn't there exposure to air and then I am attaching the new tpn/l, could I be pushing air into the line then???  I'm really confused, if anyone could clarify this for me I would really appreciate it, sorry if I am using the wrong medical terms or leaving something out!



Chris Cavanaugh
Are you clamping the IV

Are you clamping the IV access (PICC, TLC, Broviac or PIV) before you stop the pump?

The IV access needs to be clamped every time you disconnect the tubing. 

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Mike Brazunas
Also, ask your fellow RNs in

Also, ask your fellow RNs in the NICU; on most (if not all) modern pumps, the tubing clamps automaticaly when you take it out of the pump. 



Mike Brazunas RN


Please try toask your
Please try toask your hospital educator for proper handling of the iv tubings/pumps before you use it, as well as the senior rns in your unit.
The specific steps in the

The specific steps in the process will depend upon the exact brand of pump being used. Can you attach the new tubing to the new fluid container and prime it manually? Or does it require that you prime it or fill it with fluid to purge the air while the tubing is one the pump? All pumps have anti-free flow mechanisms now. So when you remove the old tubing from the pump it is automatically shut off and there is no fluid infusing. So if you can prime the tubing manually, leave the old tubing in the pump and infusing while you prime the new tubing. Time the tubing change with a change of the fluid container. Do not attach new tubing to an open fluid container if you can avoid it. The old tubing is still infusing while you are priming the new. Then stop the pump, switch tubings and restart the pump after you have verified the correct fluid rate settings. When disconnecting any tubing or cap from any central venous catheter of any kind, close a clamp between the catheter hub and patient to prevent air from entering the system. Even small microbubbles can cause physiological changes. So always clamp the catheter before you disconnect it from any tubing or injection cap. Finally, work with a preceptor or educator in your facility to make sure you are doing this correctly, along with knowing the written policy and procedure in your facility.  

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

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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