Pharmacy specific orders/ instructions always supersede the Agency guidance provided below. If in doubt, do not guess, call our office, or tag @TeamHelp-CareCoordination and ask for Clinical Support.

ALWAYS establish IV access prior to mixing any meds

ALWAYS make sure you have everything you need to complete infusion before you begin

ALWAYS confirm your medication dose against the medication label and orders

ALWAYS reach out to us first (not the Pharmacy) with any questions

NEVER tell a Pt you have not given a particular medication before

GOAL: Ensure Pt can independently flush and administer TPN using proper technique. We will then see Pt for weekly dressing changes and labs (if they are ordered). :

PREPARATION

1. Prepare clean working area

2. Remove TPN from refrigerator and allow to warm to room temperature (2 - 4 hours)

3. Inspect TPN

   • If TPN contains lipids, check for “cracking” (oil slick on top surface of solution)

   • Turn the bag upside down in front of a white or black background and watch for crystals, particles, or ANY sign of cloudiness or streaking

4. Assemble supplies

   • Alcohol, 10 ml NS flush(s), Heparin for cyclic feedings, 10 ml syringe(s) and needle(s) for multivitamins/additives; tubing, Infusion pump and batteries, TPN, IV pole or backpack, Sharps container,

5. Wash hands with warm soap and water for 15 seconds or use alcohol-based hand sanitizer. 

6. Prepare multivitamins and other additives and add to TPN bag

7. Insert the tubing into the TPN bag and attach tubing to electronic pump

8. Prime the tubing until TPN fills the entire tubing line. 

9. Attach TPN to patient’s central line and follow pump instructions to begin infusion

10. Instruct patient on various alarms they may encounter and what they mean.

    
    

WHEN INFUSION IS COMPLETE

1. Turn off infusion pump (if not starting a new bag immediately.) 

2. Disconnect pump tubing from the patient

3. Flush catheter

   • If continuous feeding flush with saline

   • If cyclic feeding flush with saline AND heparin and then clamp catheter

4. Throw away all used supplies

5. TEACH patient when they restart a new bag to choose proper settings on pump

DRAWING LABS

1. Have patient pause for 20 minutes prior to drawing labs

2. Follow steps for Central Line/PICC line lab draws

3. Review order and verify/gather necessary supplies

   • If patient requests additional labs or hands you orders for additional labs DO NOT draw if they are not on the orders in your file, tag TeamHelp-CareCoordination(Best Tag)

   • We can ONLY draw labs approved by pharmacy

4. If unable to obtain labs from Central Line/PICC/Midline or Port, RN may draw labs peripherally; no special permission is needed for peripheral lab draws.

   • Reach out and tag TeamHelp-CareCoordination(Best Tag) and let agency know that you were unable to draw labs from patient’s line and that you attempted peripherally and whether you were successful or not

5. Lab tubes must be labeled with CORRECT Name and DOB and initialed, timed and dated

   • Name and DOB on tubes MUST match Name and DOB on lab req

6. Lab Reqs must be placed in the pocket of the biohazard bag

   • If you printed lab req then date and initial and place in pocket of biohazard bag

   • If you requested lab req to be faxed, you must obtain the req from the facility, then date and initial and place in pocket of biohazard bag BEFORE leaving the facility

ADDITIONAL INFORMATION

Dressing Change Policy:  HHC Dressing Change Policy 

PICC Line In-service:  2022-Nov-PICC Line Care

Drawing up Vitamins: Vitamins-TPN

Videos for Pumps and TPN: TPN at home via Curlin Pump and TPN Instruction CADD Solis

PICC line blood draw video:  Blood draw from PICC

HHC Blood Draw Policy:  Blood Draw Practices & Procedures

Lab In-Service:  2023-Aug-Labs 

How to Draw Labs With a Butterfly:  Labs-Butterfly