Hello everyone I am new in the NICU and have some questions about CVL/PICC. Â If anyone could help or direct me to a website I would really appreciate it! Â I have spent hours online trying to find a direct answer but I didn't have any luck.
1. Â 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. Â 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). Â I just don't understand this and I cant get an answer from anyone, Â I'm really worried that I am doing something wrong!
2. Â 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. Â 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) Â that connects to the white adapter leg. Â What worries me is Â 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??? Â 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!