Sign Up
For the best experience, choose your profession & state.
You are not currently logged in. Please log in to CEUfast to enable the course progress and auto resume features.

Course Library

LPN IV Series: Parenteral Nutrition

2 Contact Hours
CEUfast OwlGet one year unlimited nursing CEUs $39Sign up now
This peer reviewed course is applicable for the following professions:
Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN)
This course will be updated or discontinued on or before Thursday, June 1, 2023

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.

This course is 1 of 8 courses available on CEUfast to meet the 24 hour written portion of the Florida LPN IV Certification requirement. The remaining 6 hours on the return demonstration of IV skills must be completed in person. To find a provider, or if you are interested in becoming a provider, refer to our Provider Information page.

100% of participants will be able to administer parenteral nutrition.


After completing this continuing education course, the participant will be able to meet the following objectives:

  1. Discuss the indications for PN administration.
  2. Identify the types of PN.
  3. Discuss administration of PN.
  4. Monitor for complications of PN.
  5. Discuss multi-lumen central VADS.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Last Updated:
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Authors:    Wesley Hunter (RN, PMT) , Desiree Reinken (MSN, APRN, NP-C) , Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)


Parenteral nutrition (PN) is feeding nutritional products IV. The usual process of eating and digestion is bypassed.

PN is indicated for the following conditions(Nettina, 2019):

  • Patients who cannot tolerate enteral feeding
    • Paralytic ileus
    • Intestinal obstruction
    • Acute pancreatitis
    • Severe malabsorption
    • Persistent vomiting and the jejunal route are not possible
    • Enterocutaneous fistula
    • Inflammatory bowel disease
    • Short bowel syndrome
  • Hypermetabolic states where enteral therapy is not possible
    • Burns
    • Trauma
    • Sepsis
  • Patients with specific nutritional needs that are not met by enteral feeding
There are three types of PN:
PN Type (Nettina, 2019)CompositionNotes
Total nutrient admixture (TNA)
  • 20%-70% dextrose
  • 3%-15% proteins in the form of amino acids
  • Lipids 10%-30% emulsion composed of triglycerides, egg phospholipids, glycerol, water
  • Vitamins
  • minerals
  • Must infuse through a central line
  • Indicated when parenteral feeding is for 7 or more days
Peripheral parenteral nutrition (PPN)
  • Less concentrated dextrose
  • Amino acids
  • Vitamins
  • Minerals
  • Lipids
  • Fewer calories
  • Sometimes has higher lipid calories than carbohydrate calories
  • May infuse through a peripheral line
  • Indicated when parenteral nutrition is less than 7 days
Total Parenteral Nutrition (TPN)
  • Dextrose
  • Amino acids
  • Vitamins
  • Minerals
  • Must infuse through a central line
  • TPN and lipids may be given intermittently or mixed together

TNA (Nettina, 2019):

  • Must be given through a central line
  • May be ordered before surgery to improve fluid, electrolyte balance and nutritional status
  • May be ordered if unable to take food or fluids orally
  • May be necessary to correct protein deficiency from chronic obstruction, paralytic ileus or infection
  • Severe diarrhea
  • Rest the intestinal tract and restore nitrogen balance
  • Combines dextrose, amino acids, vitamins, and minerals
  • Given through a central IV line

TPN and lipids may be given intermittently or mixed together

Fat Emulsion (Lipids)

  • 10%-30% emulsion composed of triglycerides, egg phospholipids, glycerol, water and vitamin K
  • Lipids may be given centrally or peripherally

A filter should be used if possible. A 0.22-micron filter is used for PN without lipids.

A 1.2-micron filter is used for TNA with lipids.

PN cannot be administered with any other solutions, medications or blood.

When changing tubing in a central line, have the patient perform a Valsalva maneuver to prevent air from being sucked into the tubing.

Tubing used for parenteral nutrition should be changed every 24 hours. Tubing for fat emulsion infusion must be changed every 12 hours. Use strict sterile technique when changing tubing or dressings.

Check frequently for tolerance and complications.



Complication (Nettina, 2019)CausesMonitor for signsIntervention
  • High glucose content of fluid
  • Venous access device contamination
  • Temperature
  • WBC
  • Insertion site infection
  • Maintain sterile technique when changing dressing and tubing
  • Consider removal of venous access device with replacement of alternative site
  • If blood culture is positive, the provider may institution of antibiotics
Electrolyte imbalance
  • Iatrogenic (caused by the treatment, in this case, PN administration)
  • Effects of underlying disease (fistula, diarrhea, vomiting
  • Blood sample contaminated by PN
  • Electrolytes initially at least daily
  • Treat underlying cause
  • Provider may change concentration of electrolytes in PN
  • Insufficient insulin secretion
  • High glucose content of PN
  • Blood sample contaminated by PN
  • Frequent blood glucose
  • Administer insulin
  • Provider may decrease glucose content of PN
  • Abrupt discontinuation of PN
  • To stop PN, reduce rate by 50%, then DC after 2 hours
  • If PN must be stopped abruptly, hang a separate dextrose solution if insulin has been administered
  • Iatrogenic
  • Underlying disease (CHF, renal failure)
  • Intake and output (I&O)
  • Daily weights
  • Central venous pressure (CVP)
  • Breath sounds
  • Peripheral edema
  • Provider may order more concentrated PN
Hyperosmolar diuresis
  • High osmolarity of PN
  • I&O
  • Daily weights
  • CVP
  • Provider may decrease concentration of PN
Hepatic dysfunction
  • Iatrogenic
  • Liver function
  • Triglycerides
  • Jaundice
  • Provider may change macronutrients in PN
  • Excessive calories
  • Provider may reduce calories
Lipid intolerance
  • Low birth weight or premature neonate
  • History of liver disease
  • History of elevated triglycerides
  • Bleeding (occult blood in stool, coagulation studies, platelet levels)
  • SAO2
  • Fat overload syndrome
  • Triglyceride levels
  • Liver function
  • Hepatosplenomegaly
  • Decreased coagulation
  • Cyanosis
  • Dyspnea
  • Allergic reaction (nausea, vomiting, headache, chest pain, back pain, fever)
  • Administer lipid solutions slowly initially, while observing for allergy symptoms
Lipid particulate aggregation
  • Unstable mixture of dextrose solution with lipids
  • Observe for cracking or creaming of fluid and discontinue or do not use lipids with these characteristics

Long-term VADs

  • Hickman
  • Broviac
  • Groshong
  • Peripherally inserted central catheter (PICC)

A multi-lumen central VAD allows concomitant administration of PN and other solutions, including medications or blood. The different lumens do not mix because the lumens end at different lengths along the catheter. So, the two lumens are infusing at different locations.

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)

Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


  • Nettina, Sandra M., “The Lippincott Manual of Nursing Practice” 11th Ed. Wolter Kluwer, Philadelphia, 2019.