Total Parenteral Nutrition (TPN) & Tubes Flashcards
What is parenteral nutrition ?
when a pt’s GI tract is not functioning or when a pt can’t physically or psychologically consume sufficient nutrients orally or enterally
- enteral means by the means of the intestine
What is Total Parenteral Nutrition (TPN) ?
- everything the pt needs nutritionally is in the bag
- pt needs intense, nutritional support for an extended period of time
- high caloric need
- hypertonic solution (>10% dextrose ) so need through a central line cause it will burn and burst a peripheral vein)
- long term therapy
What is Peripheral Parenteral Nutrition (PPN) ?
- pt can take in some nutrition through GI tract
- less calories per day
- nutritionally incomplete solution (low dextrose content)
- isotonic (<10% dextrose and <5% amino acids)
- can be given up to 14 days
- can be given through peripheral veins
What may be in a Parenteral Nutrition bag ?
bags are specialized to each pt’s labs
- protein (amino acids): determine by liver and kidney function
- carbs (dextrose): determines by blood glucose and if on a fluid restriction (if on fluid restriction then a higher concentration of glucose in bag)
- fats (lipids)
- electrolytes
- vitamins (vitamin K)
- trace elements in sterile water
- Regular insulin to prevent hyperglycemia
- Heparin to prevent fibrin buildup in catheter tip
What are some considerations about giving lipids (fats) in a bag ?
- combo of soybean oil, safflower oil and egg phospholipids
- be look milky or opaque appearance
- gives essential calories when dextrose amounts must be reduced due to persistent hyperglycemia or fluid restriction
Why may lipids be contraindicated in a pt ?
- severe hyperlipidemia
- severe hepatic disease (fat is metabolized by the liver so if not working properly then lipids won’t be able to be broken down)
- high risk of fat embolism (femur fracture)
- allergy
What are a three-in-one infusions ?
contains lipids, dextrose, and amino acids in 1 bag
- can reduce body carbon dioxide production and buildup of fat in the liver
- not in all hospitals so may need to be given separately
When initiating TPN what should we consider ?
- TPN bag must be out of fridge for at least 1 hr to be able to be hung (want room temp)
- need a filter because TPN contains lots of things
- connect filter straight to the line
- don’t need filter for lipids
- need 2nd nurse to confirm components
What are some safety considerations for the tubing/dressing of TPN ?
- clean IV tubing with aseptic technique (higher dextrose= bacterial growth)
- sterile dressing changes for PICC/Central line q4 days
- bag and tubing must be changed every 24 hrs (often infusion is due to be changed at every shift change)
What do we do if our TPN bag isn’t ready on time ?
give pt Dextrose 10-20% until you get the next bag
- if stopped abruptly it can cause hypoglycemia because body was used to high levels of glucose
What is Refeeding Syndrome ?
when the body rapidly changes from catabolic state (starvation) to anabolic state (building nutrition)
- can cause fluid and electrolyte imbalances
- can cause: shallow respirations, confusion, seizures, cardiac rhythm changes, fluid retention, acidosis, weakness
What conditions must be met for a pt to be discontinued off TPN ?
get 60% or more of caloric requirements through oral or enteral nutrition
- want transition to be gradual (weened off) to avoid rebound hypoglycemia
- when transitioning slowly introduce enteral or oral nutrition (liquids should be clear, low in fat and non-irritating to GI tract)
What should we do if a TPN has an oily appearance and layer of fat is on top of the solution ?
do not administer it
- notify pharmacy and return the bag to them
What is a salem pump ?
rigid with larger circumference and interior lumen
- for suction and feeding
- gastric placement only
What is a Small Bore Feeding Tube (SBFT) ?
- for feedings only
- can be in stomach or small bowel
- interior lumen much smaller
- soft sided
- aka “Corpak” or “Dobhoff”
