Help! Kabiven TPN administration during HD

[bluefabian]

My next shift tomorrow requires me to give a TPN by the name of Kabiven to a patient during HD and I never done it before. Since I will be the only nurse working there tomorrow (it's a part time job), I have nobody to refer to since I will be the only dialysis trained nurse in the hospital! The next staff will only come at the end of shift. Sorry, but I just got to know about this very late into the last shift.

My questions:-

1. How do you administer the TPN? I mean only through central venous catheter right mostly? So far, I didn't get the information whether the patient will be on central vascular access or peripherals.

2. I assume the amount of fluid is to be taken into the total extraction?

3. How long is the duration of the infusion? At what time do I start the infusion (i mean, halfway through dialysis or near the end, etc).

4. Any special consideration or precautions during the infusion?

Thanks for all the help.

[chatty-rn]

I give IDPN (intradialytic parenteral nutrition) at a chronic unit. It comes directly to the unit from the company. The rate is already figured to cover the length of the treatment. Each pt. has an individulized prescription for it. We hook it by the venous chamber to the pigtail. We add the IDPN volume to the removsl goal. On the diabetic pts we check blood sugars pre-tx, mid-tx, and post-tx. Some pts get insulin at the start of the tx to cover the IDPN. Most pts have seen an improvement in their albumin levels and energy.

[bluefabian]

A bit late but thanks!!!

I administered the Kabiven with the pt having BCF access. At first I was alarmed by that but was calmed down when I saw that it was made specially for peripheral administration - glucose level at 11%, still OK right?

I was unable to give it via the venous chamber due to the design of the set that has no other outlet other than the venous pressure line. It was made a practice by the staff to administer the TPN through the infusion line. Which is a bit puzzling since it passes the dialyzer. When I asked the staff about the possible of the nutrients being dialyzed, she said the molecular size was bigger. But I was not satisfied with that.

TPN is usually given in a course of 12-24 hours right? If this is done in CRRT, usually in Critical Care I wouldn't have asked much. But giving this in a period of 4 hours is too fast in my opinion. And add that to the volume of the TPN which was 1.4L being added to the total UF.

Plus there are other issues that ran through my mind at the time like: glucose level, electrolyte and minerals levels with fluid change. Admittedly, it was quite overwhelming.

And a good experience.