What is the issue with letting a TPN bag run dry?

[Sparda29]

---

Members do not see this ad.

We're having issues at my hospital with this. The policy apparently is that a TPN should be started at 10PM. Now, somewhere down the line a few days ago, someone in the pharmacy gave the nurse the TPN a few hours too early, and it was started around 7-8PM. Now, the nurses call almost every day at 7-8PM looking for the TPN while I'm refusing to give it since it's supposed to start at 10PM.

Nurse keeps telling me that the TPN is about to go dry. Now, what is the issue with the patient having no TPN for a few hours? If they're worried about hypoglycemia why not just switch over to some D10 for a couple of hours?

 

[crazybob]

Is it because of dehydration or something?

 

[npage148]

Send it 15 min later each night starting at 8. By 6 nights or so they'll be on the right schedule!

 

[mustang sally]

We're having issues at my hospital with this. The policy apparently is that a TPN should be started at 10PM. Now, somewhere down the line a few days ago, someone in the pharmacy gave the nurse the TPN a few hours too early, and it was started around 7-8PM. Now, the nurses call almost every day at 7-8PM looking for the TPN while I'm refusing to give it since it's supposed to start at 10PM.

Nurse keeps telling me that the TPN is about to go dry. Now, what is the issue with the patient having no TPN for a few hours? If they're worried about hypoglycemia why not just switch over to some D10 for a couple of hours?

My director got pretty upset when this happened in our hospital as well. I'm not sure what the actual clinical issue is, but can't you just change the schedule in the computer for this one pt to reflect what actually happened? That seems like it would be better than withholding TPN bags.

 

[rxlea]

My director got pretty upset when this happened in our hospital as well. I'm not sure what the actual clinical issue is, but can't you just change the schedule in the computer for this one pt to reflect what actually happened? That seems like it would be better than withholding TPN bags.

Rebound hypoglycemia.

 

[FCMike11]

We're having issues at my hospital with this. The policy apparently is that a TPN should be started at 10PM. Now, somewhere down the line a few days ago, someone in the pharmacy gave the nurse the TPN a few hours too early, and it was started around 7-8PM. Now, the nurses call almost every day at 7-8PM looking for the TPN while I'm refusing to give it since it's supposed to start at 10PM.

Nurse keeps telling me that the TPN is about to go dry. Now, what is the issue with the patient having no TPN for a few hours? If they're worried about hypoglycemia why not just switch over to some D10 for a couple of hours?

Just going to say this out loud...
*nurse pages doctor* "Yes Dr. X, could we start D5/D10?"
"Huh? This patient is on TPN, why do the fluids need to be changed?"
"Pharmacy wont release it unti 2200"
*click* (or insert some berating comment here)

Sorry I know you posted this for clinical information...just pointing out that piece.

Sent from my SAMSUNG-SGH-I747 using Tapatalk 2

 

[Sparda29]

Just going to say this out loud...
*nurse pages doctor* "Yes Dr. X, could we start D5/D10?"
"Huh? This patient is on TPN, why do the fluids need to be changed?"
"Pharmacy wont release it unti 2200"
*click* (or insert some berating comment here)

Sorry I know you posted this for clinical information...just pointing out that piece.

Sent from my SAMSUNG-SGH-I747 using Tapatalk 2

Yeah, that doctor would probably get disciplined.

My director got pretty upset when this happened in our hospital as well. I'm not sure what the actual clinical issue is, but can't you just change the schedule in the computer for this one pt to reflect what actually happened? That seems like it would be better than withholding TPN bags.

Yeah, I ended up calling the director before the confrontation with the nurse turned nasty. This chick wouldn't leave the issue alone even though I had the CCU calling me for Levophed drips, some code in the catscan needed an amiodarone bolus + drip, respiratory arrest in the ER needs something else, all while my partner is on lunch break and this nurse is hounding me for a ****ing TPN for a hospice patient.

Director said to just give it to them and he'll make sure their supervisor knows about it the next day.

 

[PharmDstudent]

We're having issues at my hospital with this. The policy apparently is that a TPN should be started at 10PM.

Why on earth would your facility start TPNs at 2200? When are your hs doses being given? Hopefully not before 2200, because if they are, then you may be giving insulin doses prior to hanging a new bag of TPN... so if the TPNs are late, you could end up with:

Rebound hypoglycemia

That can happen with TPN weaning, too.

If the patient is on achs sliding scale and long-acting insulin, I would be very hesitant to withhold their TPN. At least with the sliding scale you could withhold the next dose in anticipation of a drop in blood sugar (if everybody's on the same page 😉) but you can't control basal insulin in the same way.

...just wait until there's another D50 shortage and the patient codes!

 

[Sparda29]

Why on earth would your facility start TPNs at 2200? When are your hs doses being given? Hopefully not before 2200, because if they are, then you may be giving insulin doses prior to hanging a new bag of TPN... so if the TPNs are late, you could end up with:That can happen with TPN weaning, too.

If the patient is on achs sliding scale and long-acting insulin, I would be very hesitant to withhold their TPN. At least with the sliding scale you could withhold the next dose in anticipation of a drop in blood sugar (if everybody's on the same page 😉) but you can't control basal insulin in the same way.

...just wait until there's another D50 shortage and the patient codes!

Our tpns usually arrive at 8pm from the company who makes them for us. On the off chance they arrive earlier we hold them until 10pm.

 

[zelman]

Why on earth would your facility start TPNs at 2200? When are your hs doses being given? Hopefully not before 2200, because if they are, then you may be giving insulin doses prior to hanging a new bag of TPN... so if the TPNs are late, you could end up with:That can happen with TPN weaning, too.

If the patient is on achs sliding scale and long-acting insulin, I would be very hesitant to withhold their TPN. At least with the sliding scale you could withhold the next dose in anticipation of a drop in blood sugar (if everybody's on the same page 😉) but you can't control basal insulin in the same way.

...just wait until there's another D50 shortage and the patient codes!

Can't you just add regular insulin to the TPN for basal coverage?

 

[PharmDstudent]

Can't you just add regular insulin to the TPN for basal coverage?

Sometimes patients are already on basal insulin whenever you start TPN.

 

[maldini99]

Can't you just add regular insulin to the TPN for basal coverage?

you dont want to do that, delivery of insulin to the patient can vary and it is much more controlled out of the bag