Colleagues,
 
 
I need some assistance with writing a policy to cover patients who are on TPN and the central line
is accidentally removed.  Our current policy (which dates back to 1998) states that 10% Dextrose must
be started with in 10 minutes.  We all know we shouldn't give D10W through a PIV.  The INS "blue book" states in the "unstressed patient, rapid tapering can be accomplished by reducing the rate by 50% during the first hour and by 50% during the second hour.".  The blue book also talks about using D5W instead of D10W. 
 
At conference I heard someone talk about doing hourly blood sugars and only start fluids if the patient shows signs of trouble when the catheter was accidentally removed.  What do you have in your policy concerning accidental catheter removal?  Any literature that addresses this issue?
 
Thanks for your help.
Margy Galloway
 
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