Wendy Erickson RN
Eau Claire WI
Yes, that is my question as well, do you mean TPN when you say CPN? If so, and you were running PNN through a central line you could deffinately switch to TPN without a promlem because it's still a CL that it is running through, but you would still ramp up to the desired dose.
I always look to the INS standards of practice first as my guide, which say that if the solutions final concentrations exceed 10% dextrose, 5% protein, a PH less than 5 or greater than 9, and an osmolarity greater than 600mOsm/L it should go through a central line. PPN by rights should not exceed the above guidlines to meet the standards fo peripheral infusion, so if you are already using a central line you could switch over to TPN without a problem.
Tara Dennis, RN,BSN,CRNI
Victoria Sallese, RN, VAT, PICC service
Actually the term "PPN or peripheral parenteral nutrition" is outdated. Those formulas are rarely used any longer plus the fact that the osmolarity of the lowest concentration exceeds the max of 600 mOsm that should be infused through a peripheral vein.
My first thought from the question was concern about infection. All CVCs will have biofilm but if there are no clinical signs and symptoms of any type of infection, there should be no problem with switching the concentration of the components of the formula. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
I would like to clarify the abbreviations used during this exchanged and then ask a question--PPN does NOT mean Peripheral Parenteral Nutrition it actually translates to Partial Parenteral Nutrition--Perhaps this misinteruptation gave the impression that it was OK for peripheral administration despite it's osmalarity--Is CPN a new abbreviation? What is it's translation and does it refer to all Parenteral Nutritions?--We recently had a patient with a Single Port--TPN and assorted other IV Medications where required--I remember hearing at an AVA conference that the Port should not be used for the TPN in the instance--A PICC should be inserted to accomadate the TPN and the PORT reserved for other medication to perserve and protect it's integrity ie infection control issues--Commments Please
Robbin George RN VA-BC
This is from the Clinimix website:
CLINIMIX sulfite-free (Amino Acid in Dextrose) and CLINIMIX E sulfite-free (Amino Acid with Electrolytes in Dextrose with Calcium) injections are sterile, nonpyrogenic, hypertonic solutions, available in 1- and 2-liter CLARITY multi-chamber bags for central and peripheral parenteral nutrition.
Perhaps this may also have something to do with the misunderstanding.
I agree with Victoria. Culture the line first. If the patient has no signs of a CRBSI, the TPN can be started after the blood culture is done. Wait for results in a few days.
This is assuming proper catheter tip positioning.
The response to this question has nothing to do with Clinimix.
Reid Nishikawa, Pharm. D.
Coord Clin Services
RA Nishikawa, Pharm. D., BCNSP, FCSHP
Coordinator, Clinical Services
Director of Research
Elk Grove, CA
In a hospitalized patient, you may not have the luxury of waiting 2 - 3 days to begin PN depending upon their clinical status. That is one problem with waiting for cultures. Another is that most catheters that have been in use will be positive when a blood culture is drawn from the lumen. So then you have waited to find a contaminated line. Now you have to arrange to have another line inserted which takes additional time. So the nurse is caught in a catch-22 situation - a patient with severe nutritional deficits, possible instability and no progression to being discharged and waiting for culture results or a new line. Not a good situation. The other option is to draw cultures, begin PN infusion, then act upon the culture results when obtained. You must make a choice on risk vs benefit for each patient. Lynn