TPN

A. TPN- total parenteral nutrition- delivery nutrition through large bore veins when GI delivery not possible

1. Subclavian or jugular2. Start gradually 40-60mL to avoid hyperglycemia- pancreas needs time adjust insulin output

B. METHODS DELIVERY1. Central venous access

i. CVCii. PICCiii. High calorie, high protein needs

2. Peripheral venous accessi. Cephalic or basilic veinsii. Lower calorie & protein needs, supplement oral intake, central access to risky

C. NURSING INTERVENTIONS1. Assess VS q4-8hrs2. Daily weight3. Monitor labs: blood glucose (q406hrs), BUN, creatinine, e-lytes, CBC w/ WBC, hepatic

enzymes4. I/O5. Assess infection6. Change dressing & tubing7. Assess re-feeding syndrome8. Monitor flow rate &volume9. Assess complications10. Assess cardiac status11. Ass s/s over-hydration

D. COMPLICATIONS1. Infection2. Metabolic probs: hyperglycemia, hypoglycemia, hyperlipidemia, fluid volume overload, pre-

renal azotemia, e-lyte imbalance, essential fatty acid & vit. Deficiency3. Mechanical problems: catheter insertion—air embolism, pneumothorax, hemothorax,

chylothorax, pyrothorax, hemorrage4. Dislodgement5. Thrombosis of vein6. phlebitis