Home care patient is managed by physicians in several different health systems :( Physicians are disagreeing with what VAD is appropriate or not for TPN 14 hours daily, and twice weekly 0.9 NaCl hydration. The existing single lumen port was just replaced with a double lumen at the patient's insistence, and some physicians do not want the existing PICC removed stating TPN and hydration should be infused in separate DEVICES.
My thoughts: Two devices increases risk of line related infection and the PICC should be removed. The double lumen port can be used for a dedicated TPN lumen, the other lumen for hydration.
I also question whether a dedicated lumen is even required if the only other therapy is 0.9 hydration (I am not including the issue of blood drawing).
Your thoughts?
Forum topic
Wed, 06/04/2014 - 18:38
#1
TPN, 0.9 NaCl hydration -dedicated line required?
Is the patient an oncology patient? I have found some oncologists are of the mindset that they do not want TPN infused through an implanted port. I am not sure what their reasoning is on that but maybe others in this site might have an anwser to that.
Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
When the ASPEN guidelines suggesting a dedicated line for TPN were written, they were not terribly clear. The Dedicated line simply means, based on the literature they used to write the guidelines, that once a catheter has TPN infusing, no other medications should be given through that line. This is to reduce the risk of incompatible medications mixing with the TPN and causing preciptation or other complications if the line is not adequately flushed.
If the patient is not receiving any other medications, then the do not need the PICC. The Double lumen port should have one lumen dedicated to the TPN and nothing else infusing or given through it. If the hydration is given when the TPN is infusing, it can be given through the other port. The two lumens of the port are two separate and distict catheters, they do not allow infusions to mix. Keeping another line, such as the PICC, increases the risk for infection and other complilcations such as thrombosis.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC