TPN

Question 1

preferred admin route

Answer 1

via CVC

Question 2

when would you NOT continue current TPN orders?

Answer 2

when any of the following values are outside the norm:

• Na+
• K+
• serum glucose
• P+
• CO2
• Mg+
• ionized Ca+

Question 3

if TPN is not available, what do you do?

Answer 3

hang D10W at 50mL/h and if not available after 4h, notify TPN prescriber

Question 4

according to VIHA protocol, in what circumstances would you need to call the physician?

Answer 4

if central line site is inflamed, temp exceeds 38.4 orally or equal to more than 39 rectal/tympanic

Question 5

if there is a suspected infection, what assessment findings would you see and what interventions would you complete?

Answer 5

• redness, pain, swelling, purulent drainage

- notify MRP, cleanse area, obtain C&S swab if one was not sent within past 72h

Question 6

if there is a systemic infection, what assessment findings would you see and what interventions would you complete?

Answer 6

• fever, rigors, elevated WBCs, weakness/dizziness, hypotension, confusion
• notify MRP, obtain blood culture if not done within past 24h, 2 separate blood culture sites are recommended

Question 7

if cannula tip is suspected to be infected, what do you do?

Answer 7

cleanse site with NS, on removal hold device away from skin, cut distal 3cm off tip and send for C&S

Question 8

if fluid appears or smells unusual, what does that mean? what do you do?

Answer 8

• TPN has been contaminated
• discontinue TPN, clamp tubing and send with fluid bag for C&S; if cannula was removed, send for C&S
• notify pharmacy, MRP, infection control