Potential Complication of TPN

[liser79]

Hello all.

Looking for some opinions.

I am a nursing student with a quiz question that states what is a potential complication for TPN.

My fellow students and I are torn between elevated blood glucose and increase in temp.

My understanding is hyperglycemia and infection are both complications of TPN.

So to all experts out there....

Which do you consider to be correct if you only had to choose one?

Thanks for the help.

Lisa

[MedSurgeMess]

elevated glucose is the most common complication

[flightnurse2b, LPN]

yeah, i would def go with hyperglycemia.

[morte, LPN, LVN]

def the hyperglycemia

[RheatherN, ASN, RN, EMT-P]

hyperglycemia i agree. we do Q6 hr blood sugars becuz of that. there can be insulin in the TPN, but we may still need to do sliding scale insulin to cover them yet.

-H-RN

[meandragonbrett]

TPN can QUICKLY lead to hypersomolar hyperglycemia.

[blondy2061h, MSN, RN]

Hyperglycemia. That's a direct effect from the TPN. Fever may be an effect from the infection that may happen if the TPN is handled improperly. Really though, patients shouldn't get an infection from TPN.

[IVRUS, BSN, RN]

Hello all.

Looking for some opinions.

I am a nursing student with a quiz question that states what is a potential complication for TPN.

My fellow students and I are torn between elevated blood glucose and increase in temp.

My understanding is hyperglycemia and infection are both complications of TPN.

So to all experts out there....

Which do you consider to be correct if you only had to choose one?

Thanks for the help.

Lisa

Well, I have a different take on this.

While Hyperglycemia is a real issue with pt's on TPN, it is assessed frequently with q 6 hour FSBS. A temp increase, however, can signal line sepsis, or full blown septicemia. TPN is a very rich bag of nutrients and bacteria love it! So, if the nurse doesn't scrub the hub, or injection cap at the end of the patient's IV catheter with a good 30 second scrub like a "juicer", bacteria at cap's end will migrate into the catheter and "seed" inside the IV catheter, or inside the pt. Or, if strict sterile technique is not employed with the hook up of the tubing, or if the pharmacy failed to use appropriate techniques when placing the additives, bacteria is introduced. And in some cases, the patient may exhibit all the s/s of septicemia with fever, chills, HA, malaise, and the MD says "Ah ha, The catheter is the culprit!" This may, or may not be the case. Sometimes, the pt will have Hematogeneous Seeding occur. This is where bacteria from a distant foci travel through the bloodstream and collect on the IV catheter and though the pt appears septic, the real issue is the need to resolve the infection from that distant foci (whether that is an infected decub, or G-tube site, etc.) So, in my world.. A fever is more problematic.

Hope it helps.

[Blackheartednurse]

and there is always risk for aspiration...

[meandragonbrett]

and there is always risk for aspiration...

Everybody is always at risk of aspiration. Aspiration tends to occur more frequently with enteral rather than parenteral.