Total Parenteral Nutrition
- Dysfunctional GI tract
- GI surgery
- Intolerance to tube feedings
- Malnutrition from burns, cancer, or chemotherapy
- Least desirable form of nutrition. Only used when it is the only choice.
Indications
TPN
Administration
- Administered via central line, peripherally inserted central catheter, or implanted vascular access
- Hypertonic (high concentration of solutes and glucose > 15%
Composition
- Glucose concentrations varies from 5% to 70%.
- Amino acids
- Lipids
- Vitamins
- Electrolytes
- Insulin to counteract high glucose content.
Nursing Interventions
- Never stop TPN abruptly, wean down.Â
- Once discontinued check blood sugar 1 hour after.Â
- Weight patient daily
- Never increase rate for “catch up”
- Monitor I & O
- Aseptic Technique when changing TPN
- Hang D10W if you run out of TPN
- Monitor glucose every 4 hours with insulin sliding scale
- Monitor Electrolytes
- Return cloudy/dark solutionÂ
- Must be hung within 24 hours of preparation by pharmacy
Complications
Peripheral Parenteral Nutrition
- Given through a peripheral IV
- Low glucose concentration (< 12.5% glycose)
- Used for short term (5 to 7 days)Â
- Used when client needs smaller concentration of carbs, fats, and proteins
- PPN delivers isotonic or midly hypertonic solutions since highly hypertonic solutions can cause sclerosis, phlebitis, or swelling to peripheral veins.