TPN questions

I'm doing a little research on TPN policies and have some questions:
1. Do you give TPN via a peripheral line ever? (PPN)
2. Do you always stop the TPN for lab draws (even if the TPN is in a central line and the draw is peripheral?)
3. Do you add insulin to the TPN for elevated blood sugars or do you run a seperate insulin drip?
4. Do you infuse other meds into a line that has TPN running in it?

Thanks for your help.
Celia
I work in peds...so ours may be different than yours...I'm doing a little research on TPN policies and have some questions:1. Do you give TPN via a peripheral line ever? (PPN)NO!!!! There have been TONS of incidences where there were HORRIBLE infiltrates-this is why we never do this. 2. Do you always stop the TPN for lab draws (even if the TPN is in a central line and the draw is peripheral?)We always stop if we are drawing from central line, not usually if draw is periph.3. Do you add insulin to the TPN for elevated blood sugars or do you run a seperate insulin drip?NEVER add insulin, always start drip.4. Do you infuse other meds into a line that has TPN running in it?It depends if it is compatible or not (if it is, we run it), and (since we always run thru a central) if we have a double or triple lumen or not..etc..

1. There is a different concentration of parenteral nutrition which can be given peripherally. This is PPN. It is different from TPN. TPN can only be administered via a central IV line.2. You do not have to stop TPN to draw blood peripherally. TPN should not be stopped abruptly as this can cause hypoglycemic reactions. Labs should never be drawn from a central line through which TPN has been infusing.3. Elevated serum glucose levels may need to be treated by adding insulin to the TPN, using SQ insuling and supplementing with an insulin gtt if needed. If you are using an insulin gtt, you can piggyback the gtt in at the port below the filter that is in your TPN line and run it on a separate pump.4. There are some medications that are compatible with TPN, insulin, lipids, and some antibiotics--I just always call pharmacy first and make sure that I piggyback everything below the filter.Hope this helps

Quote from Celia MI'm doing a little research on TPN policies and have some questions:1. Do you give TPN via a peripheral line ever? (PPN)2. Do you always stop the TPN for lab draws (even if the TPN is in a central line and the draw is peripheral?)3. Do you add insulin to the TPN for elevated blood sugars or do you run a seperate insulin drip?4. Do you infuse other meds into a line that has TPN running in it?Thanks for your help.Celia

Quote from Celia MI'm doing a little research on TPN policies and have some questions:1. Do you give TPN via a peripheral line ever? (PPN)2. Do you always stop the TPN for lab draws (even if the TPN is in a central line and the draw is peripheral?)3. Do you add insulin to the TPN for elevated blood sugars or do you run a seperate insulin drip?4. Do you infuse other meds into a line that has TPN running in it?Thanks for your help.Celia

10% dextrose (PPN) may be infused in peripheral vein.20% or greater dextrose (TPN) must be infused via central venous line.Usually pt has more than one lumen for TPN so that lab draws or other meds can be given via other lumen.

Originally Posted by Celia MI'm doing a little research on TPN policies and have some questions:1. Do you give TPN via a peripheral line ever? (PPN)2. Do you always stop the TPN for lab draws (even if the TPN is in a central line and the draw is peripheral?)3. Do you add insulin to the TPN for elevated blood sugars or do you run a seperate insulin drip?4. Do you infuse other meds into a line that has TPN running in it?Thanks for your help.Celia1. TPN only through central lines. In the unusual event that a patient does not have a central line on my unit (Bone Marrow Transplant), we have one placed before TPN is started.2. Yes. Unless they are peripheral blood cultures, all labs are drawn through a central access device. Having TPN run through the other lumen can alter results such as the CBC as well as the chemistry. It is off for less than 5 minutes. I flush the line, waste 10cc's and draw my labs.3. Our pharmacy will add insulin to the TPN and if it isn't sufficient, we cover patients with Regular Insulin QID - or if that isn't sufficient, we start an insulin gtt.4. I will Y in compatible meds below the filter. Tacrolimus and Cyclosporin are TPN compatible and is a lifesaver when you have a double lumen PICC, TPN running through one lumen and a pile of IV meds that are timed to go in over 2 hours.Hope this helps!Blee

Well, I work in the NICU, and our babies usually have pretty limited IV access. Most of the time we have peripheral IVs, PICC lines, and umbilical catheters. Once in a great while, we'll have an older baby with a Broviac line. But we do give TPN daily to about 50% of our patients, so I'll join in...1. Yes, we give it peripherally. The dextrose has to be 12% or less, and the protein levels are lower as well. Usually this is a case where it's a new baby who hasn't had a PICC line placed yet, or a baby who did have a PICC line that got infected, and we won't typically place a new PICC until blood cultures are clear.2. In the rare case that we have a Broviac, we'll stop the TPN, flush the Broviac, draw off 3cc of blood and then draw the labs. However, we never draw glucose or electrolytes off a line that had any dextrose/electrolyte solution running throough it. Otherwise, we'll draw the blood elsewhere while the TPN continues through the PIV, PICC, or UVC.3. We always start a separate line for insulin drips and run it by itself.4. We infuse whatever we can with the TPN! Again, limited IV access. According to pharmacy, NOTHING is compatible with TPN, but we have published charts that show what is actually compatible at the Y-site. If it's okay there, better believe we're going to use that line! We never have double lumen lines if it's a PICC, only if it's a UVC.

Same as Gompers, except we do put insulin in TPN. Do you know why your facility doesn't Gompers? Just curious.

Quote from Celia MI'm doing a little research on TPN policies and have some questions:1. Do you give TPN via a peripheral line ever? (PPN)2. Do you always stop the TPN for lab draws (even if the TPN is in a central line and the draw is peripheral?)3. Do you add insulin to the TPN for elevated blood sugars or do you run a seperate insulin drip?4. Do you infuse other meds into a line that has TPN running in it?Thanks for your help.Celia

Quote from pvjerrys10% dextrose (PPN) may be infused in peripheral vein.20% or greater dextrose (TPN) must be infused via central venous line.Usually pt has more than one lumen for TPN so that lab draws or other meds can be given via other lumen.

Quote from fergus51Same as Gompers, except we do put insulin in TPN. Do you know why your facility doesn't Gompers? Just curious.

The reason that some facilties do not add insulin to the TPN , especially in some NICUS, is that the baby's needs are constantly changing. The TPN goes up for 24 hours, and would be very expensive to have to keep changing it during the day. Much easier to have is separate for that case.