I would appreciate thoughts on a problem occurring for those on HPN. About 10mths ago the supplier changed the tubing for the pumps used for those on HPN, from normal diameter to the micro size, in that time about 8 members of the support group have noted and identified that when sticking the spike into the bag, it slips in more than easily, and the PN fluid drips out, until it is pushed and twisted fully in, taking some effort.
There has been two suggestions, the supplier/pharmacy of the PN, advises to get another bag, and tubing and try again. This of course means unscrubbing, getting another bag out and warming it, and of course about an hour or twos delay. For some hospital departments who have money signs in their eyes they wont allow an extra bag to be ordered and so the child has to make do on dext 10% overnight.
The other suggestion is to just wipe it clean with a chlorhexidine swab then push the spike in until leakage stops.
Meanwhile the suppliers/hospital staff all try to blame the carer,consumer, YET when they go back to another type pump +tubing ,no further problems. I personally have been accessing IV bags since 1966, so think by now I have the technique fairly well under control. It is not every tubing in the batch.
On looking, there does not seem to be a diameter or bevel difference, no sign of a barb or hole in the spike.
This has now gone on since about Nov 2011.
the hospitals that organise the prescription like to say no one else has complained, not realising that several members of the group actually use that same hospital and have complained. We seem to hit the rock face of apathy. The dispensing supplier say its not for them to recall as the pump/tubing come via another firm. and dead silence from that firm.
My question is, would you toss the bag and tubing, or just accept that the drips are coming out so not likely to cause contamination, scenario.
OR because these children especially, are at greater risk for CVAD infection they should go hungry instead.
I would NEVER accept this situation. If fluid can drip out, microorganisms can get in. So these children are definitely at a risk for contaminated fluid and possible infection. Additionally, remember that bugs (real ones, not the microorganism kind) will also be attracted to the sugar dripping out on to the tubing, pump, floor, etc. I once saw an ant, yes a real ant, floating in a bottle of TPN hanging on a patient. This was during the summer months when they were the most active seeking a meal and we were using glass bottles with a straw tube for venting. So this situation is a risky one. If this is home care, are the parents or other caregivers actually spiking the bag? If so, could they be putting it in at a slight angle causing the spike to puncture the bag and leak out? I have also seen that problem and it requires that the bag immediately be changed. Remember any PN solution is going to support the growth of candida very easily. So something must be done about this situation to protect your patients. I would immediately change both the tubing and container when any leakage is found. But I would continue working to resolve this problem for all patients. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861