Parenteral NutritionBy

Dr. Hanan Said Ali

Objectives

• Define parenteral nutrition..

• Explain how to prepare the patient.

• Explain how administer parenteral nutrition .

• Demonstrate the care of patient with a parenteral nutrition..

• Identify complications of it.

Parenteral Nutrition

It has two forms: Total Parenteral nutrition

Is the intravenous infusion of water, protein, carbohydrates, electrolytes, minerals and vitamins through a central vein.

Peripheral Parenteral nutrition

Delivered into the smaller peripheral veins, cannot handle as concentrated a solution ( maximum 10% dextrose).

Parenteral Nutrition

Dextrose, amino acids, electrolytes, vitamins, and minerals are mixed together in one container and infused as the primary TPN solution.

Lipid emulsions containing primarily essential fatty acids are administered from a separate container through a Y- connector into the TPN intravenous line.

Parenteral Nutrition

Complications of TPN Significant changes occurs in the client's fluid,

electrolyte, glucose, amino acid, vitamin, and mineral levels.

Hyperglycemia, hypoglycemia, acidosis.

Electrolyte deficiency or excesses such as hyprekalaemia, hyponatremia, and hypocalcemia

Parenteral Nutrition

Patient Preparation Gather the patient data. Know the

purpose of the TPN. Confirm the physician” order for the

TPN. Obtain vital signs, including recent

body temprature; client” weight; fluid balance; and any allergy to content of the TPN solutions.

Parenteral Nutrition

Equipment

TPN solution Timing tape Infusion pump Tubing with filter

Parenteral Nutrition

Preparation Inspect and prepare the solution

Remove the ordered TPN solution from the refrigerator 1 hour before use, and check the proposed rate.

(cold cause pain, hypothermia, and venous spasm and constriction)

Inspect the solution for cloudiness or presence of particles.

Parenteral Nutrition

Preparation Cont. Check the expiration date, it must be used

within 24 hours of preparation.

Performance Explain the procedure. Provide the client privacy. Prepare the client: Check the client”s identification band. Assisst the client to a comfortable position.

Parenteral Nutrition

Performance Wash hands Observe appropriate infection control procedures. Change the solution container to the TPN solution

ordered. Ensure that correct placement of the central line

catheter by x- ray. Ensure that the tubing has an in- line filter

connected at the end of the TPN tubing.

Parenteral Nutrition

Performance Attach and connect the tubing on an infusion pump. Attach the TPN solution to the IV administration

tubing. Regulate and monitor the flow rate. Establish the prescribed rate of flow and monitor the

infusion at least every 30 minutes. Never accelerate an infusion that has fallen behind

schedule ( Wide fluctuations in blood glucose can occur if the rate of TPN infusion is irregular)

Parenteral NutritionPerformance Never interrupt or discontinue the infusion abruptly.

( if TPN solution is temporarily unavailable, infuse a solution containing at least 5 percent dextrose. This prevents rebound hypoglycaemia)

Closely monitor vital signs, and signs of any side effects at the first hour ( fever, flushing, diaphoresis, dyspnea, cyanosis, headache, nausea, or vomiting)

Parenteral Nutrition

Start lipid infusions very slowly according to the physician's orders.

Monitor the client for complications: Change the administration set and filter every 24 hours.

Monitor the vital signs every 4 hours ( an elevated temp. Indicate catheter – related sepsis)

Collect double- voided urine specimens to test the specific gravity, if it abnormal, notify the physician, who may alter the constituents of the TPN solution

Parenteral Nutrition

Assess finger stick blood glucose levels every 6 hours.

Measure the daily fluid intake and output and calorie intake.

Monitor the results of laboratory test and report abnormal findings.

Parenteral Nutrition

Assess weight and anthropometric measurements:

Weigh the client daily, at the same time and in the same garments ( a gain of more than 0.5 kg per day indicates fluid excess and should be reported).

Measure arm circumference and triceps skinfold thickness weekly.

Parenteral Nutrition

Document all relevant information: Type and amount of infusion. Rate of infusion. Vital signs q 4h. Fingerstick blood glucose levels. Client's weight daily. Anthropometric measurements.

Thank You