Administering TPN

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Administering TPN Through A Central Line:

Administering TPN Through A Central Line

TPN is a specialized form of nutritional support in which nutrients are given intravenously :

TPN is a specialized form of nutritional support in which nutrients are given intravenously

TPN is infused into a large-diameter vein, such as the superior vena cava :

TPN is infused into a large-diameter vein, such as the superior vena cava TPN solutions are usually hyperosmolar, and thus you have to administer them into a large-diameter vein to prevent sclerosis of vein tissue

Examples of central venous access devices include central venous catheters, peripherally inserted central catheters (PICCs), and implanted infusion ports :

Examples of central venous access devices include central venous catheters, peripherally inserted central catheters (PICCs), and implanted infusion ports

Central Venous Access Devices:

Central Venous Access Devices Central Venous Catheter PICC Implanted Infusion Port

Selection of the ideal vascular access device depends on client factors, device characteristics, therapeutic issues, and duration of therapy :

Selection of the ideal vascular access device depends on client factors, device characteristics, therapeutic issues, and duration of therapy

Client Factors:

Client Factors Condition of veins Hypercoagulability state Skin disorders Known allergies to catheter materials Altered dexterity Developmental disabilities Needle phobia Body image impairment Previous experience with vascular access device

Device Characteristics:

Device Characteristics Design of device Low risk for infection (e.g., antibacterial coatings )

Therapeutic Issues:

Therapeutic Issues Number of lumens Durability Characteristics of solutions or emulsions Dextrose concentration >10% requires central vein access Solution with osmolarity >600 mOsm /L requires central vein access

Indications for TPN :

Indications for TPN Nonfunctional GI Tract Extended Bowel Rest Preoperative

Nonfunctional GI Tract:

Nonfunctional GI Tract • Massive small bowel resection/GI surgery/massive GI bleed • Paralytic ileus • Intestinal obstruction • Short bowel syndrome • Trauma to abdomen, head, or neck • Severe malabsorption • Intolerance to enteral feeding • Chemotherapy, radiation therapy, bone marrow transplantation

Extended Bowel Rest:

Extended Bowel Rest • Enterocutaneous fistula • Inflammatory bowel disease exacerbation • Severe diarrhea • Moderate to severe pancreatitis

Preoperative TPN:

Preoperative TPN • Preoperative bowel rest • Treatment for comorbid severe malnutrition in patients with nonfunctional GI tracts • Severely catabolic patients when GI tract nonusable for more than 4 to 5 days

Parenteral nutrition includes mixtures of carbohydrates (10% to 70% dextrose solution), amino acids (protein/nitrogen), fats (fatty acids), electrolytes, vitamins, and trace elements (e.g., zinc, copper, and chromium) :

Parenteral nutrition includes mixtures of carbohydrates (10% to 70% dextrose solution), amino acids (protein/nitrogen), fats (fatty acids), electrolytes, vitamins, and trace elements (e.g., zinc, copper, and chromium)

The TPN and mixture that is used depends on the clients needs This determination is made by the physician and nutritional support team A doctors order is required to administer TPN:

The TPN and mixture that is used depends on the clients needs This determination is made by the physician and nutritional support team A doctors order is required to administer TPN

Assessment:

Assessment Assess indications of and risks for protein-calorie malnutrition Inspect condition of central vein access site Assess vital signs, auscultate patient's lung sounds, and measure weight Consult with physician and dietitian on calculation of calorie, protein, and fluid requirements for patient Verify physician's order for nutrients, minerals, vitamins, trace elements, electrolytes, and added medications as well as flow rate. Check for compatibility of added medications

Planning:

Planning Expected outcomes following completion of procedure : A . Patient's ideal weight gain is usually between 1 and 3 lb. per week B . Serum glucose levels are less than 150 mg/ dL or maintained between 80 and 110 mg/ dL . Check physician's order for desired glucose range C. Central venous access device is patent, and site is free of pain, swelling, redness, or inflammation D. Patient is afebrile 2. Explain purposes of TPN 3 . If TPN solution is refrigerated, remove from refrigeration 1 hour before infusion

Implementation:

Implementation Strict aseptic technique is required Perform hand hygiene and apply clean gloves

Slide 20:

Compare label of TPN bag with medication administration record (MAR) or computer printout; check for correct additives and solution expiration date. Also check patient's name Inspect TPN solution for particulate matter or, if it is a 3:1 solution, inspect emulsion for a cream layer or separation of fat into a layer. If there is a thin layer of aggregated fat droplets about 1 to 2 cm in thickness, invert bag back and forth gently to mix

Slide 21:

Identify patient. Use at least two patient identifiers

Slide 22:

Attach appropriate filter to IV tubing . Prime tubing with TPN solution, making sure no air bubbles remain, and turn off flow with roller clamp. Connect end of tubing to appropriate port of central catheter, and label port. Open roller clamp to rate that maintains patency of line

Slide 23:

Place IV tubing into IV infusion pump, open roller clamp completely, and regulate flow rate on pump as ordered

Slide 24:

The port being used for TPN should be dedicated to TPN administration ONLY. Infuse all IV medications or blood through an alternative IV line. Do not obtain blood samples or central venous pressure readings through same lumen or port used for TPN

Slide 25:

Do not interrupt TPN infusion (e.g., during showers, transport to procedure, blood transfusion), and be sure that rate does not exceed ordered rate

Slide 26:

Change infusing tubing and filter using strict aseptic technique. Change IV administration sets for TPN every 72 hours, for 3:1 and fat emulsions every 24 hours, and immediately upon suspected contamination

Slide 27:

Discard used supplies, and perform hand hygiene

Evaluation:

Evaluation Monitor flow rate routinely, at least hourly Monitor fluid intake every 8 hours Obtain daily weights or weights as ordered Assess for fluid retention; palpate skin of extremities, auscultate lung sounds

Slide 29:

Monitor patient's glucose level every 6 hours or as ordered, and monitor other laboratory parameters daily or as ordered Inspect central venous access site Monitor for fever, elevated white blood cell count and malaise

Documentation:

Documentation Record condition of central venous access device, rate and type of infusion, catheter lumen used for infusion, intake and output (I&O) every 8 hours, blood glucose levels, vital signs, and weights

The End:

The End http://findarticles.com/p/articles/mi_qa3689/is_200111/ai_n8997797 / “Administering Total Parental Nutrition” Edwina A McConnell November 2001

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