A nurse is caring for an adult client receiving central venous total parenteral nutrition (TPN) at 75 mL/h. Which actions reflect safe TPN management? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
TPN is a high-alert hyperosmolar formulation. Standard safety: independent two-RN verification, glycemic monitoring (q4-6 h initially), dedicated central lumen, and replace with 10 percent dextrose at the same rate if TPN is not immediately available to prevent rebound hypoglycemia. Each TPN bag is changed every 24 hours, NOT 48, due to bacterial growth risk in lipid emulsion.
Clinical Judgment TPN safety: two-RN verification, dedicated central line lumen, 24-hour bag change, glucose q4-6 h, do not abruptly stop. Hyperglycemia risk early; rebound hypoglycemia if abruptly stopped (taper or hang 10 percent dextrose). Daily weight, electrolytes, BUN/creatinine, LFTs, triglycerides.
Memory Tip TPN: 2-RN check + Dedicated lumen + 24-h bag + Glucose q4-6h + Taper or D10W
KR vs U ASPEN and Korean Society for Parenteral and Enteral Nutrition (KSPEN) follow the same safety principles. Both endorse refeeding syndrome screening (electrolytes baseline) and gradual rate increase over 24-48 hours.
Clinical Practice GuideASPEN TPN safety bundle:- Two-RN check at every new bag and rate change- Dedicated central line lumen; no piggyback or simultaneous medications- 24-hour bag change regardless of remaining volume- Glucose q4-6 h initially, then per stability- Daily monitoring: weight, intake/output, BMP, LFTs, triglycerides, fluid balance- Refeeding syndrome screen: phosphorus, potassium, magnesium baseline and trended- Taper when discontinuing; if interrupted, infuse 10 percent dextrose at same rate to avoid rebound hypoglycemia- Filter change with bag change
CautionCLABSI risk is high in TPN clients. Strict aseptic technique for line care and tubing change. Notify provider for fever, chills, hyperglycemia trending up, or LFT abnormalities.
TPN (total parenteral nutrition) — Hyperosmolar nutrition delivered via central venous catheter when enteral feeding is not possible. Composition: dextrose, amino acids, lipids, electrolytes, vitamins, minerals. Requires dedicated lumen, glycemic monitoring, and refeeding-syndrome surveillance.
Refeeding syndrome — Severe electrolyte and fluid shifts when nutrition restarts after prolonged starvation. Hallmarks: hypophosphatemia, hypokalemia, hypomagnesemia, fluid overload. Risk highest in first 24-72 hours. Start TPN slowly, replete electrolytes before and during, monitor labs every 12-24 hours initially.
Rebound hypoglycemia — Sudden hypoglycemia after abrupt cessation of TPN due to continued endogenous insulin response to recent high-dextrose infusion. Prevent by tapering TPN and, if interrupted, infusing 10 percent dextrose at the same rate while a new bag is prepared.