Yeah maybe, but then what would be the normal process if a bag needs to be replaced unexpectedly? Maybe someone who knows more about TPNs can help. Is it that it can be given cold but ideally shouldn't for comfort like injections, or is it a hard rule?so if a TPN wasn’t out of the fridge at 11 when this was apparently changed. Not ready!, we can either assume the nurse used the same TPN bag then (as she didn’t wait 4 hours for it to cool down (edit -warm up). Or they had one ready and waiting which would have had to be taken out when letby was on shift ? Do you see what I’m saying.
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that’s what I’m wondering, I genuinely have no idea. Interesting though
A crime took place when the first poisoned bag was given to the babies. Nothing after that, however important anyone feels it is, changes that initial crime surely? Ben has to make you believe it’s possible someone else did it. If it was once I still would struggle to get there. It’s twice, so no I wont be. Anybody is entitled to any opinion they like on who commits the actual crime that took place, whether it be Letby or whether it had to have been somebody else.
I think the real problem here is the (apparent) lack of documentation. The nurse has said what she should have done not what she has done. There should be proof on the second bag administration either way. Does it not exist? I’m tending to believe the second bag was not a stock bag if there is no documentation that it was. Maybe it will become clearer.
I understand your reasoning that if there was some question about whether a second bag was needed LL might have ‘helpfully’ set it up. Would the constituents of a stock bag be very different to a bespoke bag?
Also, stock bags, what is there shelf life and expiry date, would the one to be used first be on the top?
There is no doubt in my mind that LL hung the first contaminated TPN bag.
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Exactly this where is the evidence saying it was changed ? You would think there would be some wouldn’t you. Another reason why I think the nurse just changed the lines and not the TPN bag. Perhaps more will come out on this though like you say and it will become clearer either way.
I don’t really think the ‘second bag’ existed if I’m honest. But if It did perhaps this is one way for it to have occurred. Just a theory.
I want to ask about the lines baby F had. Reading the wiki, baby F was having TPN through a long line. Do these ‘tissue’ in the way that a peripheral IV line would? I thought the end would be much further along the vein and any leakage would be internal? Am I wrong? Could LL have tampered with the line in some way?
The TPN was changed to a peripheral line, which is acceptable, I believe, infection wise, and stopped at 11am.
I could be going off on the wrong track regarding the lines but just wondering.
The TPN was changed to a peripheral line, which is acceptable, I believe, infection wise, and stopped at 11am.
I could be going off on the wrong track regarding the lines but just wondering.
I don’t know the process of TPN else where especially not with neonates. I work in a adult ICU so know nothing about babies at all. We don’t have stock of TPN. Emergency stock is available out of hours but would be dispensed to us from pharmacy.that’s what I’m wondering, I genuinely have no idea. Interesting though
The bags actually don’t come up cold (maybe because they are freshly made), say 3 individual bags were sent up for a patient, I would use one immediately, then the other two i would put in the fridge for the next few days. On those a consecutive days either myself or another nurse on would try and remember to take out the bag needed 4 hours before. If I forgot, which I have done I would delay the next TPN until that time has passed. I think giving it cold would cause shock to the body, it enters straight into the blood stream through big vessels so would cool down your body temp dramatically i imagine.
A blood transfusion is somewhat similar. Blood given through a peripheral line say in the hand etc is fine cold, but through a central line must be warmed. There is a machine that does this, like an attachment to the pumps but I’ve never seen anything like that used for TPN. This has never happened to me, but I guess my only options would be to discontinue the TPN and either use a stock bag in a few hours once it was room temp or I would rationalise that changing just the giving set to minimise cross infection as much as possible and reusing the bag, say in the case of this baby the low blood sugars might be enough of a reason to justify this as going hours without any nutrition would be more detrimental than any risk of infection. Except this isn’t what the nurse said happened or was documented which confused me. I personally think this is the most likely situation it’s just a shame that poor documentation isn’t going to be able to prove it was indeed the same bag Letby put up as I think the idea of a second bag just allows for the defence to dispute that Letby had anything to do with a second bag. Sorry-if it’s not at all helpful, hopefully someone who knows more will be able to fill the gaps.
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Thank you yes that was helpful. I think we are some what on the same page that the bag was never changed. I mean a new bag was ordered at the later 4pm change (the only change imo), if one was ordered (I’m assuming from the pharmacy in this case) surely 11 am bag too would have been documented also?
So we have three scenario’s here, 1, the nurse changed the bag with another contaminated which for one reason or another was ready and waiting. 2, she used a cold bag, I don’t think that would be appropriate (also where would the contamination come from
). Or 3, she never changed the bag and has either forgotten or is lying now. I don’t think it was done out of malice but perhaps she thought that was the best option at the time. I can’t imagine she would want to administer a cold bag just out the fridge to a tiny neonate and I can’t imagine she would have wanted to wait either, so reusing the bag seems perfectly acceptable in some ways.Regardless of the second bag or same bag, I struggle to see how it discounts Letby as the problem? Or makes it somehow less clear that the person there for both poisonings probably committed them… or if it’s somebody other than Letby, are they setting her up? Did a different person poison the first bag to the one that poisoned a second bag?Thank you yes that was helpful. I think we are some what on the same page that the bag was never changed. I mean a new bag was ordered at the later 4pm change (the only change imo), if one was ordered (I’m assuming from the pharmacy in this case m) surely this too would have been documented.
So we have three scenario’s here, 1, the nurse changed the bag with another contaminated which for one reason or another was ready and waiting. 2, she used a cold bag, I don’t think that would be appropriate (also where would the contamination come from
Highly unlikely.
it doesn’t in my opinion. I think it was letby. if anything I think it strengthens the evidence we have heard so far concerning the blood sugar readings etc and how the pattern played out while baby f was connected to the TPN bag. Just fits better imo that the bag was never changed, I don’t think it had anything to do with anyone else. Don’t know about other posters I’m just musing over it all x
I’ve got waaaaay to much time on my hands today recovering after a hectic week and havn’t got off my phone
sorry all 
The 'vagueness' and the proffering of a number of different scenarios which have essentially been retro-engineered from a later blood test result suggests to me that they don't have a complete documentary record, ie they have a record of an intervention at 10am, and the replacement of a tissued long line, but they DON'T have a record of whether a new bag was connected or the existing TPN bag was reused. I think you are absolutely right, the bag being reused is the most logical explanation because if they have a paper trail for a second bag that changes things completely.What you have said above, in much better detail is, why I think the first bag and second bag are the SAME! I do think she contaminated the first bag, the baby was in no doubt administered synthetic insulin, his blood sugar readings etc showed this. We can’t say oh perhaps that other nurse was the poisoner because it wouldn’t fit with what was happening to the baby prior to the tissuing of the line.
The first bag was 100 percent contaminated. The bag not being changed when the line tissued is for me the most logical explanation out of the three (also this bag was tested). I do think they will have a job in proving this sadlyand we are back to the whole scenario of sub-optimal care coupled with a murderer it seems.
Why would you apologise for that, not sure why anybody has to have their time spent here scrutinised, would be very personal imo! Some people are here reading everything and lurking, some catch up in lots of big posts, some I can see liking my posts 5 threads ago steadily ha. I’m really shocked I’m still only a chatty member myselfit doesn’t in my opinion. I think it was letby. if anything I think it strengthens the evidence we have heard so far concerning the blood sugar readings etc and how the pattern played out while baby f was connected to the TPN bag. Just fits better imo that the bag was never changed, I don’t think it had anything to do with anyone else. Don’t know about other posters I’m just musing over it all x
I’ve got waaaaay to much time on my hands today recovering after a hectic week and havn’t got off my phone
sure I won’t be by April 
This is such a good post! It’s not questioning an expert or thinking we know more, it’s pointing out glaring errors/vagueness that are coming across even to the layperson. It’s almost as if having the title ‘expert’ means that everything that comes out their mouth will be A+ when that’s not necessarily the case.
I have just realised that I thought that you @housebythesea and @hopefullynottoday were the same poster! I’m reading H and cracking on. Doesn’t make much difference just thought it was a funny observation or actually a lack of one
One area where there is no vagueness is that he’s absolutely sure the first bag is contaminated. I agree, it doesn’t look like there is a clear picture of exactly how the baby continued to be poisoned, the vagueness of that picture though isn’t the one that’s key for the crime having been committed. I don’t think it throws any shade at all on the first bag having to have poisoned the baby therefore- the issue is who did that. There isn’t any vagueness where it matters and it’s not the experts problem to say exactly how the baby continued to be poisoned, only to give possibles. He is certain the first bag is poisoned because there is indisputable evidence there.
Something you just said made things fall into place.Thank you yes that was helpful. I think we are some what on the same page that the bag was never changed. I mean a new bag was ordered at the later 4pm change (the only change imo), if one was ordered (I’m assuming from the pharmacy in this case) surely 11 am bag too would have been documented also?
So we have three scenario’s here, 1, the nurse changed the bag with another contaminated which for one reason or another was ready and waiting. 2, she used a cold bag, I don’t think that would be appropriate (also where would the contamination come from
A new bespoke TPN bag was ordered from pharmacy.
That MUST surely mean that they were using a stock bag temporarily until a new bag arrived. If they had reconnected the first bag, there would have been no reason to change it (given, of course, that they had no idea or thought that the first bag was contaminated and would not have any idea for at least another week)
Instead, the intention was to replace it with one tailored for the baby. Meaning that the bag used between 10am and 4pm had to have been a stock bag.
Not necessarily, as from an infection control point of view, if the first bag was still being used, it would be better to change it.
Also, the prescription for the new TPN bag may have changed (had it?) due to electrolyte results etc.
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