1st Year MSc Nursing Mdical- Surgical Nursing MIMS CON

1. Prepared by
Ms.Theertha P Krishna
1st Year MSc Nursing
MIMS CON

3. Definition
• Intravenous administration of varying
combinations of hypertonic or isotonic
glucose, lipids, amino acid, electrolytes,
vitamins and trace elements through a venous
access device (VAD) directly into the
intravascular fluid to provide nutrients for
patients who are unable to receive adequate
nutrition through gastrointestinal tract.

5. Purposes
• To provide nutrients required for the normal
metabolism, tissue maintenance, repair and
energy demands.
• To bypass the GI tract for patients who are
unable to take food orally.

7. Indications
• Patient who cannot tolerate enteral nutrition
because of
– Paralytic ileus
– Intestinal obstruction
– Acute pancreatitis
– Inflammatory bowel disease
– Gastro intestinal fistula
– Severe diarrhea
– Persistent vomiting
– Malabsorption

8. • Hyper metabolic states for which enteral
therapy either not possible or inadequate
– Severe burns
– NPO for more than 5 days
– Acute renal failure
– Multiple fractures
– Tumor in GI tract
• Patient at risk for malnutrition of
– Gross under weight
– Metastatic cancer

9. Methods of parenteral nutrition

10. Methods of parenteral nutrition
• Total nutrient admixture into a central vein
(TNA)
• It is indicated for patients requiring parenteral
feeding for seven or more days. Given through a
central vein often into the superior venacava.
– Parenteral formula combines
• CHO in the form of a concentrated 20-70% dextrose
solution
• Proteins as amino acids
• Lipids in the form of an emulsion (10-20%) including
triglycerides, phospholipids and glycerol.
• Water
• Vitamins and minerals

11. Methods of parenteral nutrition
• Peripheral parenteral nutrition
– This parenteral formula combines carbohydrates a
lesser concentrated glucose solution with amino
acids, vitamins, minerals
– Given through peripheral vein
– Indicated for patients requiring nutrition for fewer
less than 7 days

12. Methods of parenteral nutrition
Total parenteral nutrition
–This parenteral formula combines glucose,
amino acids, vitamins & minerals
–Given through a central I V line
–If lipids are given intermittently mixed with
TPN.

13. Methods of parenteral nutrition
• Fat emulsion (lipids):
–it is composed of triglycerides (10-
20%)
–Eg : Phospholipids ,Glycerol and water
–May be given centrally or
peripherally

14. Articles
• Central venous access devices: long term VAD
such as thick man, Broviac or Groshung
catheters or peripherally inserted central
catheter (PICC line) or peripheral IV access
• Volume control infuser
• Filters 0.22 micron for TPN (without fat
emulsion)3.2 micron filter for TNA or fat
emulsion

15. Central venous access devices

16. • Volume control infuser

17. Filters 0.22 micron for TPN / 3.2
micron filter for TNA

18. Articles
• Bag of parenteral nutrition
• Administration tubing with luer-lock
connections
• Hypo allergic tape
• Face mask
• Sterile gloves

19. Bag of parenteral nutrition

21. Procedure
Nursing action Rationale
Performing Nutritional assessment Provides baseline data
Check physician’s order Parenteral therapy must be ordered by
physician
Explain the procedure
Obtain informed consent
Collect needed equipment for the
procedure
Remove the bag of parenteral
nutrition from refrigerator at least 1hr
before procedure (if refrigerator)
Decrease the incidence of
hypothermia, pain &vaso spasm

22. Inspect fluid for presence of creaming or any
change in constitution
Indicates fluid separation TPN solution
should be clear with out clouding
Wash hands and done cap, mask, gown and
sterile gloves
Follow strict aseptic precautions
Using strict aseptic technique , attach tubing
(with filter)to TNA bag purge out air
Prevents chances of developing air embolus
Close all clamps on new tubing and insert tubing
into volume control infuses
Place the patient in supine position and turn
head away from VAD insertion site
Supine position with head turned one side
opens the angle b/w clavicle and first rib
Clean the insertion site with alcohol and
providone-iodine solution
Assist physician while inserting VAD
After insertion of VAD connect tubing to hub of
VAD using sterile technique and make sure that
the connection is secured using luer-lock
connection

23. Open all clamps and regulate
flow through volume control
infuser
Monitor administration hourly,
assessing for integrity of fluid and
administration system and patient
tolerance
Record the procedure

24. Discontinuation of TPN
• Discontinuation of TPN should take place
when the patient can satisfy 75% of his or
her caloric and protein needs with oral
intake or enteral feeding.
• To discontinue TPN, the infusion rate
should be halved for 1 hour, halved again
the next hour, and then discontinued.
• Tapering in this manner prevents rebound
hypoglycemia from hyperinsulinemia.
• It is not necessary to taper the rate if the
patient demonstrates glycemic stability.

25. Complications
• Sepsis
• Electrolyte imbalance
• Hyperglycemia
• Hypoglycemia
• Hypervolemia
• Hepatic dysfunction
• Hypercarbia