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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:
Parenteral nutrition (PN) is feeding nutritional products IV. The usual process of eating and digestion is bypassed.
PN is indicated for the following conditions1:
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)
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
Complication1 | Causes | Monitor for signs | Intervention |
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Sepsis |
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Electrolyte imbalance |
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Hyperglycemia |
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Hypoglycemia |
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Hypervolemia |
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| Provider may order more concentrated PN |
Hyperosmolar diuresis |
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Hepatic dysfunction |
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Hypercapnia |
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Lipid intolerance |
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Lipid particulate aggregation |
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Long-term VADs
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.
