picc lines and TPN

Last hospital I was at, had nurses NOT touching picc's for any reason. IV team did all the work connecting and disconnecting anything relating to the PICC including TPN. At current hospital, I was told I could interrupt the TPN running in the single lumen to flush lasix iv, protonix, etc down and reconnect the TPN as long as it was a short interruption. What is the stanDard here? Confused..........
I'm not sure what best practice is but, in my own practice, if the only access they have is a central line, you have to kinda make do with what you have! Often times, our practitioners/attendings will put in triple lumen lines. If I have TPN/lipids running through one port and then things running through the other ports that shouldn't be interrupted (ie pressors), then I really don't have much of a choice but to interrupt my TPN for a medline. Preferably, I would put a trifuse on my TPN/lipids line so I can infuse a med through the same port without breaking the line. If its a med that isn't compatible with TPN/lipids, I would pause them, flush the line, infuse the med, flush again, and restart.

TPN must go through a dedicated port and nothing else can go through that port unless you are trying to give your patient an infection.

Our hospital only uses single lumen piccs except for in ICU. I have only dealt with 1 TPN patient but it is the norm for us to interrupt TPN for other meds. If the med isn't compatible, then we have to pause TPN, flush, run med through, flush, and reconnect TPN. We avoid it when we can, but sometimes this patient needs antibiotics or prn meds and is NPO so we have no other choice. We always call the pharmacist when we get a new med order, especially antibiotics to see if we can adjust the med schedule so that we are interrupting the TPN the least we can.

At my facility, the people putting in PICCs are nurses who are PICC trained. When there is a triple lumen and we want to give them an IV push drug we pause the TPN, flush with 10 cc saline and push the IV-P drug. After that, we flush again, and restart the TPN.However, I do agree that you should never have TPN and another continuous IV med going at the same time, even if they have a triple lumen PICC line. They need a separate IV line. As a general rule (a few exceptions possible), the only thing that should run with TPN is normal saline. One previous poster that it was due to infection, but I am not clear on how this would be (doesn't s/he wasn't right). The rationale that I learned was that many meds are not TPN compatible and may not be as effective.

We frequently hang TPN/lipids and electrolyte replacements together. Talked to Pharm a couple times and they have no problem with it as the electrolytes are in the TPN we are just increasing the quantity with additional bags. But yeah at our hospital and all the ones in the surrounding area a PICC trained nurse will insert the line and then it is the staff RNs responsibility to manage it from there.

Quote from Future NP-BCHowever, I do agree that you should never have TPN and another continuous IV med going at the same time, even if they have a triple lumen PICC line. They need a separate IV line. As a general rule (a few exceptions possible), the only thing that should run with TPN is normal saline. One previous poster that it was due to infection, but I am not clear on how this would be (doesn't s/he wasn't right). The rationale that I learned was that many meds are not TPN compatible and may not be as effective.

Quote from littleneoRNThe whole point of the three lumens is to be able to run things that are non-compatible. It seems like a waste to add a PIV when you have three lumens that empty separately into the vein. In the NICU, we use TPN as our maintenance fluids and often have limited access for pressors/meds/etc. We ROUTINELY run drips and give meds with our TPN, assuming they have tested compatible. There are some incompatible that require a separate lumen or line, such as Ampicillin or Versed, but this doesn't mean there should a blanket rule. We try to interrupt the line as infrequently as possible to reduce infections, so we use a closed med line system and a 30 second scrub of the hub. Our CLASBI rate is quite low. I know this is a different population, but the IV compatibility issues are the same.

My question is why do you have to disconnect your TPN in order to admin a med? Why dont' you put a port on the line that you can use?We will clamp our line above the port, flush, admin med, flush again, then unclamp to let TPN continue running. That way we are not disconnecting anything and breaking the line.

If it's a double or triple lumen PICC, then you don't have to interrupt the TPN - just connect the other med to a free lumen. We currently have a patient on our floor who has just that - a double lumen PICC with one lumen connected to TPN+lipids and another lumen we use for her IV meds. I have only interrupted the TPN once to do her PICC dressing change.I honestly hate single lumen PICCs but they come up every now and then. If I had TPN running and had to infuse an IV med, I'd probably see if I could get a peripheral IV in so as not to interrupt the TPN. I'm not sure what our hospital standard is on that, though, since it hasn't come up yet =/

Quote from aerorunner80My question is why do you have to disconnect your TPN in order to admin a med? Why dont' you put a port on the line that you can use?We will clamp our line above the port, flush, admin med, flush again, then unclamp to let TPN continue running. That way we are not disconnecting anything and breaking the line.

Its a rare day that I have a triple lumen CVL that I'm not using all the ports of!

We use only single lumen PICCs...we use a trifurcated filter on our lines...one is for TPN, one for IL and the third is for a med line, which is a closed system. We turn off TPN, etc as needed to give meds, we never disconnect for any reason except to change lines. Our med line that goes to the trifurcated is comprised of a separate tubing which is has a flush at the end, we only disconnect at the flush syringe after cleaning the port vigorously and letting dry before hooking up the med, then repeat for the flush. We don't disconnect near the patient. We have only had 2 line infections in almost 18 months since starting this method. There are a lot of central line bundles that follow EBP and they work.