Marianne's Corner

Look Who’s Talkin!

2008-08-06T15:51:00Z

Preparing TPN, hooking up, flushing, and giving additional infusions or medications exposes the central venous catheter lumen to potential microorganisms that may contribute to catheter related blood stream infection. One activity that poses a very high risk of contamination is talking. During speaking, saliva particles are dispersed and may contain bacteria. In addition, oral abscesses, gingivitis, and cavities contribute to an even higher oral bacterial count. ...(read more)

Travel Tips

2008-06-20T00:47:00Z

Many home TPN consumers are preparing to travel to San Diego next week for the annual Oley Foundation meeting (www.oley.org). Others are planning summer vacations to beaches, camping, and even abroad.Contact your home infusion pharmacy and let them know your plans. They will advise you on whether they can ship to your travel location, or if you have to take supplies with you. Call ahead to your hotel to check refrigerator...(read more)

Cap Change

2008-05-30T22:41:00Z

Many different types of end caps or adapters are available for home TPN consumers to use on the hub (open) end of their central venous access device. There are needleless, dead end, injection ports, and split septum system caps. All connectors and caps need to be changed on a routine basis. The CDC and INS standards recommend cap change at least once weekly. In some cases, a more frequent change may be indicated....(read more)

Flushing Webinar

2008-04-27T20:45:00Z

On April 15 the Infusion Nurse's Society (INS) sponsored an on-line Webinar entitled "Current Guidelines for Flushing Vascular Access Devices." This was a live presentation by Lynn Hadaway M.Ed., RN, BC, CRNI. Lynn is a well known expert in infusion related topics and has an informative website www.hadawayassociates.com. The Webinar was accessed via personal computer and slides could be viewed while Lynn lectured. E-mailed questions were addressed following the presentation. What a great way to to attend an informative seminar from your home or office! ...(read more)

Infection Associated with TPN

2008-04-04T20:41:00Z

Total parenteral nutrition (TPN) has been identified as a risk factor for catheter related blood stream infection (CRBSI). Central venous access devices (CVAD) used to administer TPN provide a direct pathway for pathogens to enter the blood stream either from skin or hub migration. ...(read more)

Clinical Nutrition Week, 2008

2008-03-11T21:55:00Z

Several Nutrishare pharmacists, our dietician, and I attended the American Society for Parenteral and Enteral Nutrition (ASPEN) Clinical Nutrition Week in Chicago, IL last month. This conference focuses on topics related to nutritional support in the hospital and outpatient settings. Nutrition experts present a wealth of knowledge for clinicians to take back to their practice....(read more)

Central Venous Access Devices: New Technology

2008-01-30T20:59:00Z

Access devices are becoming more and more complex with various materials and configurations. A new product recently developed by Bard Access Systems™ (C.R. Bard, Inc. Salt Lake City, Utah) is called a PowerPICC Solo Catheter™. This catheter is inserted in the same manner as other peripherally inserted central catheters (PICC's) and is made of polyurethane.This PICC has a valve in the hub that simplifies care and maintenance. It can be maintained by flushing with sodium chloride...(read more)

Hospital Acquired Infections

2007-12-26T22:25:00Z

In October 2008, Medicare is changing reimbursement for preventable complications that occur during hospitalization. This means that if a home TPN consumer is admitted for another reason and a catheter related blood stream infection occurs during the hospitalization, Medicare considers this episode preventable and will not reimburse the institution for care associated with this infection. The hospital cannot bill the consumer for these un-reimbursed charges....(read more)

Catheter Ballooning

2007-12-07T22:41:00Z

Silicone tunneled catheters may develop ballooning or bulging during infusion and flushing which indicates a weakened catheter wall. This ballooning is usually noticed at the end of the catheter before the thickened area at the hub, or on double lumen catheters at the “Y” area. Polyurethane catheters (PowerLines™) are made of a more durable material and will not balloon....(read more)

Catheter Position

2007-11-04T17:22:00Z

Securing a tunneled catheter that hangs from the chest or abdominal area can be challenging for the home TPN consumer. There is a very high risk for contamination and subsequent catheter related blood stream infection when catheter tubing hangs near an ostomy, gastrostomy tube, or diaper. Tubing that gets tangled in clothing or caught on various household furnishings can cause chronic pulling at the exit site with eventual irritation or infection....(read more)