Total Parenteral Nutrition

1. Definition of "total parenteral nutrition."

1. It is a method of giving highly concentrated solutions intravenously.

2. It includes dextrose, proteins, electrolytes, vitamins, and minerals.

3. It is usually given through a central line. (Refer to Central Venous Teaching Guide.)

4. A fat emulsion, interlipids may be infused through a Y-type administration set to provide more calories.

5. It can be continuous or cyclic.

2. Rationale for receiving total parenteral nutrition therapy.

1. Inability to absorb food (gastrointestinal disease, fistula, obstruction, etc.).

2. Inability to eat for a prolonged period of time.

3. Diseases requiring the bowel or other organs to rest (pancreatitis, severe inflammatory bowel disease, etc.).

4. Malnutrition.

5. Other:                        

3. How to care for total parenteral nutrition solution.

1. Keep solution in refrigerator until about one hour before use; then allow it to warm to room temperature.

2. Always check appearance of the solution; avoid using if it is discolored or cloudy, or if sediment is present.

3. Avoid using if the solution bag is damaged in any way.

4. Avoid using if expiration date on package is past.

4. How to administer total parenteral nutrition. (Refer to Central Venous Catheter Teaching Guide.)

1. Ensure that solution is exactly what the physician prescribed.

2. Check closely for possible complications.

3. Infuse solution at exact rate ordered by physician.

4. Cyclic administration must always be started and discontinued gradually to avoid hyperglycemia or hypoglycemia.

5. Possible complications and measures to prevent them. (Refer to Central Venous Catheter Teaching Guide.)

1. Complication: Infection (symptoms are fever, redness, or pus at insertion site).  

Preventive Measures:

1. Change tubing daily.

2. Use strict aseptic techniques, especially thorough hand washing.

3. Change dressings every 48 hours.

4. Keep solutions cold until ready for use.

2. Complication: Air embolism (symptoms are apprehension, chest pain, rapid heartbeat, dizziness, bluish appearance)

Preventive Measures:

1. Tape all connections.

2. Clamp catheter before opening system.

3. Use air occlusive dressing over insertion site.

3. Complication: Hyperglycemia (symptoms are fatigue, restlessness, confusion, anxiety, weakness, perspiration)

Preventive Measure:

1. Infuse solution at prescribed rate.

2. Check urine for glucose and acetone.

3. Report early signs of hyperglycemia.

4. Complication: Fluid overload (symptoms are shortness of breath, fast heart rate, weak pulse, confusion, edema)

Preventive Measures:

1. Infuse solution at prescribed rate.

2. Report early signs of fluid overload.

3. Weigh daily.

4. Record intake and output.

5. Complication: Too-rapid infusion (symptoms are nausea, headache, lassitude)

Preventive Measures:

1. Check rate of infusion.

2. Notify physician.