Total Parenteral Nutrition

Definition

Total parenteral nutrition (TPN) is a method of supplying nutrients to the body by

infusing a specially formulated solution into the central circulation through a central

catheter.

Purposes

1. To provide essential nutrients with an intravenous solution

of carbohydrates, fats, amino acids, electrolytes, minerals
vitamins and water.
2. To maintain a positive fluid and electrolyte balance.
3. To maintain muscle mass and provide calories for metabolic demands.
Indications

1. Non functional GIT because of interruption in continuity of GIT or impaired

absorptive capacity.
2. When >7 days of nothing-by-mouth (NPO) status anticipated, as in the case
of inflammatory bowel disease, patients with an acute exacerbation paralytic
ileus or bowel obstruction
3. Specific disorders such as tracheoesophageal fistula, diaphragmatic hernia.
4. Infants with congenital or acquired disorders
5. When the patient is suffering from chronic diarrhea and vomiting or is
extremely undernourished
Equipment.
• TPN solution (Remove
TPN bag from the
refrigeration 1 hour
prior to initiation of
infusion).
• Prescribed lipid
emulsion bottle (for
separate infusion).
• Filtered IV
administration set.
• Four povidin-iodine
pads or swab sticks.
• Two 5 ml syringe.
• 10 ml vial of 0.9 %
sodium chloride.
• 10 ml vial of heparin
(10 to 100 U/ml).
• Disposable gloves.
• Tape and IV stand.
 Total Parenteral Nutrition Procedure

Steps Rational
Pre procedure :
1. Check physician order for patient name, date, To ensure safety
formula component, duration of infusion time.

2.Wash hands. To prevent transmission of infection

3.Prepare all needed equipment. To save time and effort.
4.Introduce yourself to patient. To build trust
5.Identify the patient. To ensure that, right patient receives the
intervention.
6.Explain procedure to the patient. To facilitate cooperation.
7.Keep patient privacy. To minimize embarrassment.
8.Raise bed to a comfortable working position, To prevent back and muscle strain.
usually elbow height.
Assessment
9.Assess the nutritional status of the patient as:
• Laboratory examination (as serum electrolytes,
BUN levels, Hemoglobin)
• Radiological examination.
To assess bone density.
• Physical examination and anthropometric
measurements (Patient weight, height, skin fold
thickness & arm circumference).
• Patient history (dietery history, medical and
surgical history).
10.Disinfect your hands. To prevent transmission of infection.
11.Wear clean gloves. To prevent transmission of infection.
12.Check solution for cloudiness and turbidity. To prevent transmission of infection.
During procedure :
-To prevent air embolism and blood
13.Clamp central venous catheter.
back up.

14.Clean the connector with an alcohol swab
vigorously for 30 seconds and allow to dry
15.Place IV administration set into infusion pump and -To identifying time frame for changing
label it with date and time.
16.Connect IV administration set to TPN bag.
17.Tape the connection and open catheter clamp.
18.Set prescribed rate of infusion on pump and start
pump.
19.For cycled TPN
-Infuse TPN for 1st hour at rate 50–85 ml/h then
gradually increased over 24 hours.
-One to two hours prior to end of TPN cycle, decrease
rate of TPN infusion to half.
-At the end of TPN infusion turn off infusion pump,
clamp IV tube.
-Fill syringe with 3-5 cc 0.9% saline and fill a second
syringe with 1-5 cc heparin (10-100 U/ ml).
-Flush catheter with saline then heparin.
20.Heparinize other lumens of multi lumen catheter if
not being used for infusions every 24 hours.
21.If the TPN administration is interrupted for any
reason, notify physician for appropriate orders.
-To reduce risk of infection.
IV set.
To accurate, consistent delivery of TPN.
-To prevent accidental disconnection.
-To consistent delivery of TPN to
prevent metabolic complications.
-To improve patient tolerance to
glucose load.
-To decrease pancreatic secretion of
insulin to prevent hypoglycemia.
- Saline flushes catheter lumen of TPN
solution and prevents drug– nutrient
interactions with heparin.
To prevent blood clotting in catheter
lumens.
22.During the TPN infusion monitor the patient for
signs and symptoms of metabolic-related
complications
Post procedure:
23.Dispose any used supplies. To prevent transmission of infection
24.Remove gloves and discard in proper bag. To prevent transmission of infection
1. Wash hand. To reduce transmission of infection
26.Record Date and time, Infusion rate ,The type of To ensure continuity of care
nutrition ,Patient maintained desired weight.
27.Reporting patient's reactions as: Changes in vital To ensure patient safety.
signs, Dyspnea , Dizziness ,Chest and eye pain
,Nausea and vomiting.

Complications of Parenteral nutrition

1. Inflammation and sepsis of the catheter insertion site.

2. Hyperglycemia caused by rapid metabolism of dextrose that leading to

dehydration and decreasing level of consciousness.

3. Fluid and electrolyte imbalances during the early phase of TPN.

4. Anemia and bleeding tendencies.

References

• Perry, AG, Potter, PA &Ostendorf ,WR (2018). Clinical Nursing Skills and
Techniques (9th edition) China, pp. 852-857.
• Taylor, C., Lynn, P. & Bartlett, J (2019). Fundamentals of Nursing: The Art
and Science of Person-Centered Care (9th edition) Philadelphia, Wolters
Kluwer, pp1459- 1460.