Quote from mitchsmom
I am doing a presentation on TPN & I have to make up three NCLEX-ish questions as a part of it... what do you nurses think are the top things to remember when administering/monitoring TPN in your experience? I know what my book says but I would like to use your real world feedback to make the questions.
Thanks for any thoughts!
Just a few things off the top of my head (I'm sure others will have more to add)...
Compatibility issues... very few, if any other medications/ preparations are compatible with TPN and lipids.
Central line... TPN is extremely hypertonic and irritable to veins... must be run via a central line (PPN may be run via a peripheral).
Tubing... must be changed via strict aseptic technique daily... breeding ground for bacteria due to high dextrose content.
Blood sugar considerations... accu checks (usually q 6 hrs) should be performed when someone is receiving TPN, even if the patient has no prior history of DM or blood sugar abnormalities, as hyperglycemia is the most common metabolic complication. Hypoglycemia may occur if the TPN is suddenly discontinued, rather than tapered off gradually.
Refeeding syndrome... TPN can cause electrolyte imbalances in malnourished patients, such as hypokalemia, hypomagnesemia, and hypophosphatemia.