Administering TPN


Published on

Published in: Education
1 Comment
No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Administering TPN

  1. 1.
  2. 2. AdministeringTPNThrough A Central Line<br />
  3. 3. TPN is a specialized form of nutritional support in which nutrients are given intravenously<br />
  4. 4. TPN is infused into a large-diameter vein, such as the superior vena cava<br />TPN solutions are usually hyperosmolar, and thus you have to administer them into a large-diameter vein to prevent sclerosis of vein tissue<br />
  5. 5. Examples of central venous access devices include central venous catheters, peripherally inserted central catheters (PICCs), and implanted infusion ports<br />
  6. 6. Central Venous Access Devices<br />PICC<br />Implanted Infusion Port<br />Central Venous Catheter<br />
  7. 7. Selection of the ideal vascular access device depends on client factors, device characteristics, therapeutic issues, and duration of therapy<br />
  8. 8. Client Factors<br /><ul><li>Condition of veins
  9. 9. Hypercoagulability state
  10. 10. Skin disorders
  11. 11. Known allergies to catheter materials
  12. 12. Altered dexterity
  13. 13. Developmental disabilities
  14. 14. Needle phobia
  15. 15. Body image impairment
  16. 16. Previous experience with vascular access device</li></li></ul><li>Device Characteristics<br /><ul><li>Design of device
  17. 17. Low risk for infection (e.g., antibacterial coatings)</li></li></ul><li>Therapeutic Issues<br /><ul><li>Number of lumens
  18. 18. Durability
  19. 19. Characteristics of solutions or emulsions
  20. 20. Dextrose concentration >10% requires central vein access
  21. 21. Solution with osmolarity >600 mOsm/L requires central vein access</li></li></ul><li>Indications for TPN <br />Nonfunctional GI Tract<br />Extended Bowel Rest<br />Preoperative<br />
  22. 22. Nonfunctional GI Tract<br />• Massive small bowel resection/GI surgery/massive GI bleed<br />• Paralytic ileus<br />• Intestinal obstruction<br />• Short bowel syndrome<br />• Trauma to abdomen, head, or neck<br />• Severe malabsorption<br />• Intolerance to enteral feeding<br />• Chemotherapy, radiation therapy, bone marrow transplantation<br />
  23. 23. Extended Bowel Rest<br />• Enterocutaneous fistula<br />• Inflammatory bowel disease exacerbation<br />• Severe diarrhea<br />• Moderate to severe pancreatitis<br />
  24. 24. Preoperative TPN<br />• Preoperative bowel rest<br />• Treatment for comorbid severe malnutrition in patients with nonfunctional GI tracts<br />• Severely catabolic patients when GI tract nonusable for more than 4 to 5 days<br />
  25. 25. 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)<br />
  26. 26. The TPN and mixture that is used depends on the clients needs This determination is made by the physician and nutritional support teamA doctors order is required to administer TPN<br />
  27. 27. Assessment<br /><ul><li>Assess indications of and risks for protein-calorie malnutrition
  28. 28. Inspect condition of central vein access site
  29. 29. Assess vital signs, auscultate patient's lung sounds, and measure weight
  30. 30. Consult with physician and dietitian on calculation of calorie, protein, and fluid requirements for patient
  31. 31. 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</li></li></ul><li>Planning<br />Expected outcomes following completion of procedure:<br /> A. Patient's ideal weight gain is usually between 1 and 3 lb. per week<br />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<br /> C. Central venous access device is patent, and site is free of pain, swelling, redness, or inflammation<br /> D. Patient is afebrile<br />2. Explain purposes of TPN<br />3. If TPN solution is refrigerated, remove from refrigeration 1<br /> hour before infusion<br />
  32. 32. Implementation<br />Strict aseptic technique is required<br />Perform hand hygiene and apply clean gloves<br />
  33. 33. 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<br />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<br />
  34. 34. Identify patient. Use at least two patient identifiers<br />
  35. 35. Attach appropriate filter to IV tubing.<br />Prime tubing with TPN solution, making sure no air bubbles remain, and turn off flow with roller clamp. <br />Connect end of tubing to appropriate port of central catheter, and label port. <br />Open roller clamp to rate that maintains patency of line<br />
  36. 36. Place IV tubing into IV infusion pump, open roller clamp completely, and regulate flow rate on pump as ordered<br />
  37. 37. The port being used for TPN should be dedicated to TPN administration ONLY.<br />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<br />
  38. 38. Do not interrupt TPN infusion (e.g., during showers, transport to procedure, blood transfusion), and be sure that rate does not exceed ordered rate<br />
  39. 39. Change infusing tubing and filter using strict aseptic technique. <br />Change IV administration sets for TPN every 72 hours, for 3:1 and fat emulsions every 24 hours, and immediately upon suspected contamination<br />
  40. 40. Discard used supplies, and perform hand hygiene<br />
  41. 41. Evaluation<br />Monitor flow rate routinely, at least hourly<br />Monitor fluid intake every 8 hours<br />Obtain daily weights or weights as ordered<br />Assess for fluid retention; palpate skin of extremities, auscultate lung sounds<br />
  42. 42. Monitor patient's glucose level every 6 hours or as ordered, and monitor other laboratory parameters daily or as ordered<br />Inspect central venous access site<br />Monitor for fever, elevated white blood cell count and malaise<br />
  43. 43. Documentation<br />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<br />
  44. 44. The End<br /><br />“Administering Total Parental Nutrition”<br />Edwina A McConnell<br />November 2001<br />