Total Parenteral Nutrition Flashcards
Indications for TPN
- Used to meet nutritional needs of patients who cannot via GI tract.
- Moderate to severe malnourishment
- Negative nitrogen balance
- Impaired GI tract
- Acute pancreatitis
- GI bleeding
- Episodes/exacerbations of Crohn’s disease
- Severe burns or trauma
- Liver or renal disease
- Radiation enteritis
- Terminal illness
TPN Nutrient Components
- Amino acids
- Glucose (concentration is 10% or 15-25%)
- Fat emulsion (lipids/intrapids) (may be infused separately)
- Vitamins
- Electrolytes
- Minerals
- Trace elements
- Water
Who can set up and maintain a TPN infusion?
An RN
The glucose concentration of your patient’s TPN is >10%. How should you administer this TPN?
Infuse through a central or PICC line
Can TPN be infused to a port that is used for infusing other medications?
No. TPN must be infused through a dedicated port.
How is TPN made?
Custom mix for each patient made in pharmacy under strict, aseptic technique.
How is TPN infused?
Via an infusion pump, usually over 24 hours. Must be changed every 24 hours.
Is TPN filtered?
Yes. With an in-line 0.2 micron filter. Lipids are not filtered.
Can medications be added to TPN solution bags?
No, NEVER!
Can you piggy back on TPN?
No.
Does TPN infusion require clean or aseptic technique?
Aseptic
How should TPN be stored?
Kept refrigerated until 30 minutes prior to being infused. Lipids do not require refrigeration.
What should the nurse do if TPN is not available?
Infuse dextrose 10% and water (D10W) until it is available to prevent rebound hypoglycemia
How can a separate transfusion of lipids be infused?
Peripheral intravenous catheter
What should the nurse check for prior to infusing TPN?
- Check bag against order for correct patient name, formula, components, and expiration date.
- Examine solution for turbidity, precipitation, cloudiness, holes or cracks.
How often should blood glucose and insulin administration be monitored while on TPN?
Per protocol
What should the nurse monitor a patient for who is on TPN?
- Hyperglycemia
- Hypoglycemia
- Signs of infection at central access site
- Signs and symptoms of infection/sepsis
- Fluid volume excess
- Fluid volume deficit
- Osmotic diuresis
- Electrolyte imbalances
- Monitor inputs and outputs, daily weights!
How often should the nurse check on the infusion rate and a patient receiving TPN?
Every hour to maintain prescribed infusion rate.
What is the priority to check for with patients who have central lines and are receiving TPN?
Infection!
What are the signs of a systemic infection?
- Fever
- Shakes
- Chills
- Lethargy
- Glucose consistently > 200 mg/dl
- WBC and differential
What should the nurse check for at the catheter site?
- Purulent drainage
- Edema
- Erythema
- Tenderness or discomfort
What BG level is hyperglycemia and how can it be caused?
- Glucose > 200 mg/dl
- Too rapid infusion of TPN
- Infection/sepsis
- Medication induced
- Co-existing diabetes mellitus
What BG level is hypoglycemia and how can it be caused?
- Glucose
What are the sign/symptoms of fluid volume overload?
- Tachycardia
- Hypotension
- Distended neck veins
- Weight gain
- Crackles on lung auscultation
What are the signs/symptoms of fluid volume deficit?
- Increased urine output
- Patient verbalized feelings of thirst
- Decreased skin turgor
- Tachycardia
- Orthostatic hypotension
What are the signs/symptoms of electrolyte imbalance?
- Muscles weakness
- Lethargy
- Cramps
- Muscle twitching
- Cardiac rhythm changes
How can hypertriglyceridemia be prevented?
- Infuse lipids as ordered
- Obtain baseline and weekly serum triglyceride levels or per prescriber orders
- Use caution when administering medications that are lipid based (e.g. Propofol)
