What is parenteral nutrition (PN)?
Parenteral nutrition (PN) is when nutrients are given to the client through an IV.
The client is given PN because they are unable to eat, tolerate any food in the stomach or unable to swallow.
What nutrients are included in PN?
Nutrients in PN:
- dextrose (sugar)
What allergy should be assessed for with fat emulsion/lipids?
Allergy to eggs
What is added to PN to control glucose level?
What is the difference between PPN and TPN?
PPN: partial parenteral nutrition
TPN: total parenteral nutrition
PPN: contains less nutrients and is given through a large peripheral or venous central line.
TPN: contains more nutrients and is always given through a venous central line.
What may be added to PN to prevent blood clots from forming in the tip of the central line catheter?
How should PN be discontinued?
Discontinue PN gradually over 1-2 hours to prevent sudden hypoglycemia.
How often is a new bag of PN administered?
Once every 24 hours the client gets new IV tubing and a new bag of PN.
Why are electrolytes checked daily before administration of PN?
Electrolytes are checked daily because:
- the client can get refeeding syndrome which is when there is a sudden increase of electrolytes in the blood.
Sudden electrolyte imbalances (such as potassium) can kill the client.
How is refeeding syndrome prevented?
Prevent refeeding syndrome by:
- monitor for signs of electrolyte imbalances, especially respiratory, neuro and CV changes
Notify HCP if symptoms occur.
Why is the blood glucose checked daily before PN administration?
Blood glucose is checked daily because there is glucose in PN and the complications of hypoglycemia or hyperglycemia need to be monitored.
How is hyperglycemia prevented with PN?
Prevent hyperglycemia with PN:
- begin infusion at slow rate
- check blood sugars and give insulin as needed
How is hypoglycemia prevented with PN?
Prevent hypoglycemia with PN:
- discontinue gradually
- monitor blood sugars, especially 1 hour after discontinuation
How often is blood glucose checked with PN?
Check glucose a minimum of every 4 - 6 hours while on PN.
Why are the liver labs (ALT and AST) and renal labs (BUN and creatinine) checked before administering PN?
Liver and renal labs are checked to see if there is a problem with metabolizing the proteins or fats in the PN.
Why would a client get hypervolemia as a result of PN?
Hypervolemia can occur because the fluids were given too quickly.
This can occur more frequently for clients with renal failure, heart failure or liver failure.
How is hypervolemia prevented with PN?
Prevent hypervolemia with PN:
- don't increase infusion rate
- monitor for fluid volume overload
- monitor intake and output
- monitor daily weight - goal is about 1-2 lbs (0.5-1 kg) weight gain per week
How would a client get an infection from PN?
Infection with PN can occur because there was contamination of the solution, catheter or poor aseptic technique when cleaning the catheter hub.
How is infection during PN prevented?
Prevent infection with PN:
- use aseptic technique
- scrub the hub for 15 seconds with alcohol before use
- monitor temp for infection
- assess IV site for redness, swelling, drainage
- new IV tubing and bag every 24 hours
Why is only one IV line dedicated to TPN?
The line needs to be always available for PN and nothing else - no blood or meds through that line.
This is to assure that there is always a usable line available.
Within how many hours should PN be used from initially being mixed?
Use PN within 24 hours of being mixed.
Where should PN be stored before using?
Store PN in the refrigerator.
Take it out 30 minutes to 1 hour before administration to prevent discomfort.
Can a client be on PN at home?
Yes! The client gets teaching on how to manage the central line used for PN.
Teach the client:
- how to administer
- change a sterile dressing
- get a daily weight
- monitor blood glucose
- symptoms of complications
- especially edema of arm or a fluid leak