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Nancy Sullivan
TPN infusions through a medport

I have been working at my   hospital for over 5 years and we have always infused TPN and Lipids through our ports. We now have a surgeon that puts in ports asking us to place a picc line on patients with ports for the purpose of infusing the TPN. His satatement was that they cause infection in the ports. Had a discussion with an Oncologist and an ID Doc. Onc. Dr. was on the fence post as in his previous hospital did not use ports for TPN and the ID Dr. states that ususally the infected ports he sees have underlying causes other that just TPN. Like numerous ABX killing all the flora and seeing yeast. ID doc didn't think risk was any higher with port vs picc. So here ther more information out there about ports and TPN that I am missing. Any input would be helpful. Thanks in advance.

Nancy Sullivan Rn

lynncrni
Implanted ports have the

Implanted ports have the lowest overall infection rates among all patients and therapies. So you are not missing anything. The problem with ports and TPN is the question of do you leave it accessed continuously or does the patient stick themselves nightly to start their cyclic TPN and dc the needle in the morning. I am not supportive of having a port remain accessed continuously due to the fact that there can easily be needle disldogement that leads to extravasation injury. So infection is not the biggest risk here.  

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Robbin George
There is cost and
There is cost and safety rationale for NOT using the PORT for TPN--(1) Incompatibility-- If the PORT is being used for TPN infusion than the use of all other IV infusates (At our facility this is most commonly antibiotics, chemo and pain medication) are excluded and additional IV sites are needed--(2) Statistically the high dextrose concentration of TPN increases the risk of complications requireing removal--A safer plan of care is to insert a dedicated non-tunnelled CVC (typically a PICC) that can easily be removed and/or replaced--Several years ago there was a poster presentation at AVA on this subject      

Robbin George RN VA-BC

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