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TABLE OF CONTENTS: PAGE 1) Objectives of Total Parenteral Nutrition-------------------------------------------- 1 2) Definition of Terms ----------------------------------------------------------------------- 2 3) Indications of Total Parenteral Nutrition

-------------------------------------------- 2 4) Contraindication of Total Parenteral Nutrition -------------------------------------- 2 5) Purposes of Total Parenteral Nutrition ---------------------------------------------- 2 6) Methods of Administration ------------------------------------------------------------ 3- 4 7) Types of Catheters Used -------------------------------------------------------------- 4- 6 8) Composition of Total Parenteral Nutrition Mixtures ----------------------------- 6-7 9) Guidelines, Complications and Nursing Responsibilities of Total Parenteral Nutrition ---------------------------------------------------------- 7- 9 10) Procedure Guide with Rationale ------------------------------------------------------ 11

nursing responsibilities 6) demonstrate beginning skills on TPN 1 . complications c. contraindications 3) cite the different methods of Total Parenteral Nutrition 4) identify the types of catheter used 5) state the following: a. the students will be able to: 1) define Total Parenteral Nutrition 2) enumerate the following: a. guidelines b. indications c. purpose b.Total Parenteral Nutrition Objectives: After 5 hours of classroom discussion.

or abscesses  renal or hepatic failure. PURPOSE. protein. AND CONTRAINDICATIONS OF TOTAL PARENTERAL NUTRITION Purpose:       improve nutritional status establish a positive nitrogen balance allow growth of new body tissue maintain muscle mass promote weight gain serves as alternatives for patients who are unable or unwilling to receive adequate nourishment from a normal diet Indications:  Debilitating illness lasting longer than 2 weeks. INDICATIONS. minerals.there is deficient or absent oral intake for longer than 7 days  Loss of 10 % or more of pre-illness weight  Serum albumin level below 3. TPN can be used in the hospital or at home.I. DEFINITION Total Parenteral Nutrition (TPN)   It is also known as hyperalimentation It is the intravenous administration of carbohydrates. a central venous catheter is usually required.limited volume of liquid intake  A nonfunctioning GI tract for 5 to 7 days in a severely catabolic patientbecause there is an interruption in its continuity and its absorptive capacity is impaired  Paralytic Ileus. and fat emulsions through a venous access device directly into the intravascular fluid to provide nutrients required for metabolic functioning of the body It supplies all daily nutritional requirements.food cannot move down to the stomach due to absence of peristalsis in the esophagus 2 . vitamins. electrolytes. fistulas.   II. Generally. this treatment is prescribed for patient who can’t absorb nutrients through the GI tract for more than 10 days. Because TPN solutions are concentrated and can cause thrombosis of peripheral veins.5 g/dl  Excessive nitrogen loss from wound infection.

simple IV solutions usual length of therapy using this method last for 5-10 days can irritate the intima or small veins.because there is an interruption in intestinal motility  Coma.unless psychological counseling has worked. METHODS OF ADMINISTRATION Peripheral Method solutions are infused into peripheral veins when nutritional support is needed for only short time peripheral parenteral nutrition less hypertonic. Is used to provide complete. TPN is the only way to meet the nutritional needs of someone with this illness Contraindications:        Patients who are unable to swallow Patients who are well nourished Patients who doesn’t have problem in digesting Nutritional requirements are high Inability to attain venous access Severe liver disease Abnormal lipid metabolism such as lipidemia III.it is indicated because nothing may be taken by mouth  Anorexia Nervosa. It provides more concentrated nutrition in an equal volume of fluid. causing phlebitis - - - Central Method Infuses hypertonic nutritional solutions through an indwelling central venous catheter (CVC) with the tip placed in the superior vena cava. long term nutritional support for patients who cannot or will not consume an adequate oral or enteral intake.usual food intake is not sufficient to meet the needs of the body  Intestinal Obstruction. 3 . Severe malnutrition.

where vein diameter is 5-6 millimeters . TYPES OF CATHETERS USED  Midline Catheter .lumen 4 . and easy access to the dressing site types: single. chronic vomiting.inserted through the veins in the antecubital fossa and extended 5-7 inches to the vessel. chronic diarrhea. especially that involving extensive burns multiple fractures or sepsis d. weight loss of 10% or more b.- Possible indications include: a. Acute liver and renal failure when amino acid requirements are altered e. gastrointestinal abnormalities: obstruction. after surgery or trauma. Bone marrow transplantation IV. because this area provides a stable insertion site to which the catheter can be anchored allows the patient freedom of movement. triple. severe malnutrition. double. severe acute pancreatitis c.cause less irritation because the catheter is so soft and the end is well inside the vein  Percutaneous Central Catheter used for short term ( less than 30 days) IV therapy inserted by the physician most common site is subclavian vein. impaired digestion and absorption. peritonitis. Acquired immunodeficiency syndrome ( AIDS ) f.

basilica or cephalic vein is accessed through the antecubital space and tip ends up in the superior vena cava  Tunneled Central Catheter .this cuffed and can have single or double lumens: Hickman/ Broviac and Groshong catheter 5 . a triple lumen subclavian catheter should be used because it offers 3 parts for various uses.this catheter may remain in place for many years .- - to ensure accessibility.reserved for TPN solution  18 gauge proximal port.used for immediate length (3-12 months) IV therapy .  16 gauge distal lumen.used for administering blood a port not being used can be for fluid administration can be used for drawing blood single lumen percutaneous catheter is used for administering TPN. they must be infused through a separate IV line transfusion of blood products also cannot be given through the main line  Peripherally Inserted Central Catheter . but various restrictions apply blood cannot be withdrawn from the catheter and medications be administered if medications are given.used to infuse blood or other viscous fluids  18 gauge middle lumen.

and fat in standard volumes. vitamins.implanted ports are more expensive and access requires passing a special needle (hubber-tipped) through the skin into the chamber Composition of Total Parenteral Nutrition Mixtures  Parenteral nutrition solutions include dextrose .subcutaneous port requires minimal care and allows the patient complete freedom of activity . and trace elements in sterile water. The actual composition of the parenteral solutions depends on the site of infusion and the patients fluid and nutrient requirements.instead of exiting from a skin. the end of the catheter is attached to a small chamber that is placed in a subcutaneous pocket . amino acid. Because there are standard concentration of proteins. individualization of parenteral solutions is somewhat limited 6 .- threaded under the skin to the subclavian vein. lipid emulsion. electrolytes. carbohydrate. and the distal end of the catheter is advanced into the superior vena cava 2-3 cm above the junction with right atrium  Implanted Ports .used for long term IV therapy .

The quantity of amino acids provided depends on the patient’s estimated requirements and hepatic or renal failure. In general. COMPLICATIONS AND NURSING RESPONSIBILITIES OF TOTAL PARENTERAL NUTRITION Guidelines:     Nutritional IV solution is prepared by a pharmacist Nothing should be added to hyperalimentation Insertion should be done under a strict aseptic technique TPN solutions are initiated slowly and gradually advanced each day to the desired rate  Patients should be weighed daily at the same time of the day  Main-line IV tubing and filters are changed every 72 hours. V. not 4.  Medications . and all connections are taped securely to avoid breaks in the integrity of the system  Patients should be encouraged for ambulation 7 . Carbohydrate .  Electrolytes. trace elements .The carbohydrates in parenteral solution is dextrose ( a form of glucose that contains water). medications should not be added to TPN solutions because of the potential incompatibilities of the medication and nutrients in the solution. Heparin may be added to reduce fibrin buildup on the catheter tip.A standard multivitamin preparation may be added to the TPN solution.A quantity of electrolytes provided is based on the patient’s blood chemistry values and physical assessment findings. .4 cal/g.Are sometimes added to intravenous solutions by the pharmacist or infused into them through a separate port. exact parenteral requirements for many of them are not known.0 cal/g like glucose  Protein . Although it is now recognized that minerals and trace elements are a necessary component of TPN to prevent deficiency symptoms.Protein is provided as a mixture of essential and non essential amino acids ranging in initial concentration from 5% to 15% of the solution. vitamins. GUIDELINES. which provides 3.

Excessive thirst -Fatigue -Kussmaul’s Respiration -Restlessness -Bounding pulse -Crackles on lungs -Headache -Increase blood pressure .Weight gain            8 .COMPLICATIONS    POSSIBLE CAUSE SIGNS AND SYMPTOMS -Apprehension -Chest pain -Dyspnea -Hypotension -Rapid and weak pulse -Respiratory distress -Loud churning sound over pericardium   NURSING INTERVENTION Clamp the catheter when not in use Place the client in a left side lying position with head lower than the feet Administer oxygen Instruct the client in the valsalva maneuver for tubing and cap changes Slowed infusion rate Administration of Regular Insulin as prescribed Monitor blood glucose levels Use Aseptic technique Slow or stop IV infusion Restrict IV fluids Administer diuretics Use dialysis in extreme cases Monitor intake and output Weigh patient daily Administer fluid via infusion pump Air embolism Opened catheter sytem Disconnected IV tubings Air on IV tubings   Hyperglycemia    Clients receiving solution too quickly Not enough insulin Infection Hypervolemia      Excessive fluid administration Administration of fluid rapidly Renal dysfunction Heart failure Hepatic failure -Coma .Confusion -Diaphoresis -Elevated blood glucose (≥200mg/dL) .Jugular vein distention .

Shakiness           Sepsis Poor aseptic technique Catheter contamination Contamination of solution -Chills -Fever -Elevated WBC -Erythema or discharges at insertion site     Pneumothorax Incorrect placement of catheter -Absence of breath sounds on affected site .Sudden shortness of breath -Tachycardia -Cyanosis Assess client’s history for risk of hypervolemia Monitor blood glucose Administration of intravenous dextrose Gradual decrease of PN prior to discontinue Infuse 10% dextrose at the same rate of PN Removal of catheter Obtain blood cultures Administer antibiotic as prescribed Use strict aseptic technique Monitor vital signs Change site dressing.Low blood pressure . solution and tubing as specified by agency policy Assess IV site for signs of infection Monitor for signs of pneumothorax Obtain chest X ray after insertion of catheter placement is verified 9 .Weakness .Diaphoresis .Chest or shoulder pain .      Hypoglycemia Parenteral Nutrition abruptly discontinued Too much insulin administration -Anxiety .

return the solution to the pharmacy 5. Throughout the procedure. attach a time tape to the parenteral nutrition container for accurate measurement of fluid intake\ 3. and the equipment are ready 2. expiration date. according to facility policy 6. and venous constriction. redness. When you’re ready to administer the solution. When changing for dressing the nurse and patient wear masks 6. Record the date and time you hung the fluid. and particles. and clean the catheter injection cap with an alcohol pad 7. explain procedure to the patient. swelling. If present. Observe the container for cracks and the solution for cloudiness. Gradually increase the infusion rate once the catheter position is confirmed After: 1. Confirm the patient’s identity using two patient identifiers according to facility policy. Remove the solution from the refrigerator at least 1 hour before use to avoid pain. Check the name of the solution container against the name on the patient’s wristband. which can result from delivery of a chilled solution 3. use strict sterile technique. Check the solution against the physician’s order for the correct patient name. If indicated. time and insertion 5. Instruct patient to do valsalva maneuver 2.Nursing Responsibilities: Before: 1. With the patient in the supine position. Monitor vital signs 2. a kinked catheter and skin reactions such as inflammation. and the condition of the area and the patient’s reactions are reported 10 . turbidity. Dressing and tubing are labeled with the date. hypothermia. Remove and discard your gloves 5. During: 1. Then put on gloves. Check the infusion rate every 30 minutes to 1 hour 3. tenderness 4. the patient. 7. Then put on gloves and if specified by facility policy. and formula components 4. a mask. and initial the parenteral nutrition solution container 4. Do medical handwashing. Dressing change is documented. The area is checked for leakage. venous spasm. Swab the catheter insertion site an iodine solution 8. 6. Make sure that the solution. flush the catheter with normal saline solution.

Prime the IV set using NSS. 6. Read the patient’s chart.Cebu Doctor’s University College of Nursing Mandaue City TOTAL PARENTERAL NUTRITION DEFINITION: Total Parenteral Nutrition. Place IV tubing in the kidney basin. with the NSS flowing to the kidney basin. IV tubing must be kept clean To check for the tubing’s patency. Remove the NSS and connect the tube to the RATIONALE To confirm physician’s order To decrease patient’s anxiety To prevent spread of microorganisms To save time and energy. 3. 2. Prepare the materials.9% NaCl (Normal Saline Solution) Bandage scissors Waste receptacle PROCEDURE 1. 4. Explain procedure to the patient. 5.administration of nutrients through a venous access device directly into the intravascular fluid PURPOSES:  to provide nutrients required for metabolic functioning of the body MATERIALS: A lined tray containing: Sterile kidney basin TPN bag Alcohol swabs Hypoallergenic tape IV tubing Small hypotray 0. to avoid spillage To prepare for administration . Perform medical handwashing.

To avoid leakage TPN can flow to the vein freely To promote comfort. To save time and energy To save time and energy To save time and energy To prevent spread of microorganisms So that TPN is administered intravenously. Insert the IV tube of the TPN bag into the Yport. Secure the connection with hypoallergenic plaster. 10. hypoallergenic tape. Bring the hypotray to the patient’s bedside 9. Place the primed IV tubing with the TPN bag. To promote environmental sanitation Basis for any legal purposes in the future and for endorsement to other members of the health care team . Do documentation. Do after care. Hang the TPN bag on the IV stand. 13.TPN bag 7. 12. Close off the mainline. Disinfect the Y-port of the mainline tubing using the alcohol swab. Prepare a strip of hypoallergenic tape. 11. waste receptacle and alcohol swab on the hypotray 8. 14. Make the patient comfortable. then open the regulator of the TPN set.

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