Week 4- TPN Flashcards
scope with tpn
MUST ALWAYS BE DIRECTLY SUPERVISED by a Registered Nurse:
parenteral characteristics
more
increased risk for (2)
does not require
increased
more invasive-
higher infection risk-
higher risk for metabolic complications-
does not require functioning GI tract
increased costs
continuous infusion
does not preserve GI function
enteral feed characteristics
lower risk of (3)
helps maintain __+
requires
less
lower risk of infection
lower risk of metabolic complications
helps maintain gut integrity and prevent translocation of bacteria
requires functioning GI tract
less expensive
reduced risk for refeeding syndrome
TPN is what
indications (6)
Nutritional support delivered via the bloodstream through CVAD (PICC, Percutaneous, Tunneled)
Patients with paralyzed or nonfunctional GI tract
Conditions where GI tract requires rest [i.e. bowel obstruction, ulcerative colitis, pancreatitis, short bowel syndrome]
NPO for an extended period of time
Chronic or extreme malnutrition, chronic diarrhea or vomiting requiring surgery, chemotherapy induced malnutrition
major components of TPN
6
Carbohydrates [dextrose] - provides calories
Protein [amino acid] - major structural component of cell (may also provide calories)
Fat [lipids] - provides calories and essential amino acids
Electrolytes
Vitamins
Trace elements/minerals
The combination is ordered by a physician, in consultation with a dietitian, depending on the patient’s metabolic needs, clinical hx and blood work
complications of TPN
9
**Hyperglycemia (high blood sugars)
Hypoglycemia-Initiate D10W @ same rate
Dehydration and electrolyte Imbalances
Thrombosis (blood clots)
Infection - high risk of catheter related bloodstream infection
Liver Failure
Micronutrient deficiencies (vitamin and minerals)
Hypersensitivity - fever, chills, N&V, hives, back pain, headaches, dyspnea, chest pain [monitor closely with IV Fat Emulsion]
Refeeding Syndrome
Refeeding Syndrome
Occurs when a client who is severely malnourished suddenly receives nourishment again – particularly carbohydrates
Starts with low levels of potassium, magnesium, and phosphorus
Pancreas secretes insulin so that cells can take up the sugar – but magnesium, potassium, and phosphorus are pulled into the cells along with the sugar
Dangerously low serum levels of magnesium, phosphorus, and potassium
TPN tubing
1.2 micron filter tubing-covered bag
BGM
QID BGM for first 3 days
start infusion
monitor for
Start slow using IV pump – rate determined by pharmacy-usually begin with a starter solution
Monitor for reactions - fever, chills, nausea/vomiting, hives, back pain, headache, dyspnea, and chest pain
TPN procedure
blood work drawn
how to obtain TPN order
confirm
do not use if
new tubing used
infusion rate based on
document on
infusion over 24 hours, new bags initiated at 1800 hrs, run D10W at same rate if infusion is running out prior to new bag arrival (avoid interruptions)
Blood work is drawn daily to determine the TPN components
Charge nurse or you will contact doctor with lab results and obtain TPN order
Confirm TPN components to order sheet, pt. ID, expiry
Do not use if bag leaking or TPN is lumpy, light protective bag in place
New TPN filtered tubing is primed with each new bag
Infusion rate will be based on volume labeled on bag
Document on MAR and I&O flow sheet
starting TPN
requires
when its started
- initial concentration
initial volume
body needs
must run through
medications
Requires thorough baseline assessment [history, physical, nutrition, etc]
Initial concentration of solution is LOWER
Initial volume and rate is SLOWER
Body needs time to get used to TPN
Must run through a IV pump and be infused through CVAD (dedicated lumen)
Medication CAN NOT be added to or co-infused with TPN due to high level of incompatibility
stopping TPN
- after pt is
- physician will
- pt can meet
- if no further need
- if transitioning to a tube feed
After the patient is able to get adequate enteral nutrition
Physician will re-evaluate the need for TPN
Patient can meet 70% of their protein and calorie needs
If no further need, TPN concentration will be slowly decreased over a few days until being stopped
If transitioning to a tube feed, the TPN will be tapered down while the tube feed is slowly increased
What does the nurse need to monitor after TPN is discontinued?
if tpn stopped immediatley
- monitor for hypoglycemia
- do they need D10w
