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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is caring for a client who is receiving continuous total parenteral nutrition (TPN) via a multilumen central venous catheter. Which of the following actions should the nurse include in the client's plan of care? Select all that apply.

  1. Dedicate one specific lumen of the central venous catheter exclusively for the total parenteral nutrition infusionAnswer
  2. Assess the client's capillary blood glucose levels every 4 to 6 hoursAnswer
  3. Replace the total parenteral nutrition solution bag and intravenous administration set every 24 hoursAnswer
  4. D
    Temporarily pause the continuous infusion to administer an incompatible intravenous antibiotic through the same lumen
  5. E
    Increase the infusion pump rate to catch up if the administered volume is behind the prescribed schedule
  6. F
    Draw scheduled laboratory blood samples from the specific lumen that is currently infusing the total parenteral nutrition

Answer

The correct actions are to dedicate a specific central line lumen exclusively for TPN, monitor capillary blood glucose every 4 to 6 hours, and change the TPN bag and intravenous tubing every 24 hours.
Total parenteral nutrition requires strict adherence to safety protocols due to its high osmolarity and nutrient density. It must be administered through a dedicated central line lumen to prevent drug incompatibilities. Because of the high dextrose concentration, capillary blood glucose levels should be monitored every 4 to 6 hours to detect hyperglycemia. Furthermore, to minimize the risk of severe bloodstream infections, the TPN solution and the intravenous administration set must be changed every 24 hours.

Step-by-Step Solution

1
Evaluate the requirement for a dedicated lumen.
TPN requires a dedicated lumen to prevent medication precipitation and reduce contamination risks.
Maintaining a dedicated line ensures drug compatibility and adherence to strict infection control standards.
2
Determine the appropriate blood glucose monitoring frequency.
Blood glucose must be checked every 4 to 6 hours during the infusion.
The continuous delivery of a high-dextrose solution presents a significant risk for the development of hyperglycemia.
3
Assess the protocol for changing TPN equipment.
The TPN bag and the entire intravenous administration tubing must be replaced every 24 hours.
Because TPN is highly nutritious, it promotes rapid bacterial and fungal growth if left hanging for prolonged periods.
4
Evaluate the incorrect practices regarding TPN administration.
Increasing the rate, pausing for incompatible drugs, and drawing blood from the TPN line are identified as unsafe practices.
These actions can cause fluid overload, profound hypoglycemia, line contamination, and inaccurate laboratory results.

Key Concept

Total Parenteral Nutrition (TPN) Administration and Safety Principles
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Topics

Pharmacological and Parenteral Therapies

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