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LPN IV Series: Parenteral Nutrition

2.00 Contact Hours
A score of 80% correct answers on a test is required to successfully complete any course and attain a certificate of completion.
Authors:    Wesley Hunter () , Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)

Outcomes

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

Objectives

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

  • Discuss the indications for PN administration
  • Identify the types of PN
  • Discuss administration of PN
  • Monitor for complications of PN
  • Discuss multi lumen central VADS

Introduction

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

PN is indicated for the following conditions1:

  • Patients who cannot tolerate enteral feeding
    • Paralytic ileus
    • Intestinal obstruction
    • Acute pancreatitis
    • Severe malabsorption
    • Persistent vomiting and jejunal route is 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 Type1

Composition

Notes

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:1

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 of 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 Valsalva maneuver to prevent air from being sucked into 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.

Complications

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

PN is indicated for the following conditions1:

  • Patients who cannot tolerate enteral feeding
    • Paralytic ileus
    • Intestinal obstruction
    • Acute pancreatitis
    • Severe malabsorption
    • Persistent vomiting and jejunal route is 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 Type1

Composition

Notes

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:1

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 of 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 Valsalva maneuver to prevent air from being sucked into 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.

References

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

This course is applicable for the following professions:

Licensed Nursing Assistant (LNA), Licensed Practical Nurse (LPN)

Topics:

LPN IV Series


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