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mary ferris
Tip for TPN
 I need documentation on where the tip of central line needs to be for central formula TPN. I am having debate with Md that cental formula TPN  is ok in internal jugular or subclavian
Wendy Erickson RN
The tip must be low
The tip must be low SVC/junction of SVC and right atrium.  Never subclavian.  Studies  show that the tip "whips" when in the subclavian, irritating the intima of the vessel and setting up a risk of vessel thrombosis.  When you are talking about an IJ, are you saying the tip terminates in the IJ or that it is inserted into the IJ but the tip is in the SVC?  Still needs to be low SVC. There are plenty of articles that deal with appropriate tip location of central lines - I'm sure that Lynn Hadaway can help here!

Wendy Erickson RN
Eau Claire WI

Robbin George
It sounds like someone (and
It sounds like someone (and I'm assuming it is the MD) is confusing the terms "insertion site" with "tip location"--You can have a central line inserted in the Jugular or the Subclavian but the very definition of a central line is the tip location of "Low SVC to the C-A junction"--Good luck explaining this very important detail to the MD

Robbin George RN VA-BC

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