TPN Flashcards
Major TPN Risks (3 major ones)
Infection: solution is a perfect medium for the growth of bacteria
Dehydration: TPN contains twice the amount of glucose than a regular IV solution - kidneys recognize the excess glucose as excessive and try to reduce it by excreting more (same as diabetes)
Hypoglycemia: after the first few days of TPN, a rebound effect - the body produces increased insulin.
How is TPN administered into the body?
Via a central access site or via a peripherally inserted IV catheter (PICC or directly into the subclavian vein) to avoid inflammatory reactions d/t high caloric and high osmotic fluid.
Why is TPN given?
- To reduce catabolism (protein breakdown)
- To maintain nitrogen balance
- Partial or complete intestinal failure or to promote rest
- Oral nutrition or enteral failure
- May be given in combination with enteral
TPN Risks (think about insertion/ catheter too):
- Catheter-related bloodstream infection (Sepsis or bacteremia)
- Air embolism
- Pneumothorax
- Hyperglycemia (receiving too quickly, too little insulin)
- Hypoglycemia (abrupt d/c)
What kind of osmolality are TPN solutions?
Hyperosmolar
(d/t high content in amino acids, glucose, lipids, lytes, vitamins, minerals, … than those available immediately in the intravascular compartment)
TPN: assessments
- ABCDE
- Allergies (SMOF - soy, triglycerides, oils, ..)
- Resp: LS? crackles? Tachypnea?
- CV: edema? BP? HR?
- Renal Fx: urinary output, GFR, Creatinine
- Dr. orders & RD & pharmacy (rate - usually 60mL/h, amount, contents)
- Labs, BG, I&O, weight, hydration and fluid status, PVC/CVC site, lungs
- Assess pt’s knowledge
- TPN at room temperature (mix & wait approx. 1h to warm up)
- IV tubing with proper filter - dedicated line
- 2 RNs to check
- Assess mucous membranes - might be dry for being NPO - maintain proper oral care!!
What labs need to be assessed prior to admin?
Lytes (Na, K), glucose, lipids, albumin - baseline values
How frequently to weight in the pt?
qDay until stable - twice a week after
What can be given in alternative to TPN - ex. no bag available?
Give D5W 10% - 50mL/h or Ringers Lactate to restore lytes/volume
What are the contraindications for SMOF Lipid TPN?
Known hypersensitivity to fish, egg, soybean, or peanut protein
Severe hyperlipidemia or severe disorders of lipid metabolism.
If a hypersensitivity reaction occurs, stop infusion of Smoflipid immediately and undertake appropriate treatment and supportive measures.
What is refeeding syndrome?
It happens when refeeding severily malnourished patients.
It’s characterized by the shift of intracellular potassium , phosphorus and magnesium as the pt becomes anabolic.
What is SMOF?
Sterile
Nonpyrogenic
White homogenous lipid emulsion for IV
Its contents is a mixture of soybean oil, triglycerides, olive oil and fish oil.
What reasons would make a nurse stop the TPN infusion or not admin?
Hypersensitivity reaction or s+s
abnormal VS or central line site - ? Sepsis or catheter-related infection
TPN fluid appears or smells as per usual
What meds could be added in same line as TPN?
Ranitidine
Morphine
What you should do if lab values are outside ranges:
Continue current TPN orders UNLESS (mmol/L):
• serum Na+ less than 130 or more than 145
• serum K+ less than 3.5 or more than 5.0
• serum carbon dioxide total less than 22 or more than 32
• serum glucose less than 3.9 or more than 9.0
• serum phosphorus less than 0.8 or more than 1.5
• serum ionized calcium less than 1.13 or more than 1.32
• serum magnesium less than 0.7 or more than 1.0
Notify TPN physician
