A patient with short bowel syndrome is receiving total parenteral nutrition (TPN) through a peripherally inserted central catheter (PICC). Which assessments and interventions should the nurse include in routine care to detect and prevent complications? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
TPN delivers concentrated dextrose, amino acids, lipids, electrolytes, vitamins, and trace elements through a central line and carries metabolic, infectious, and mechanical risks. Correct nursing care: (1) glucose monitoring every 4–6 hours during initiation and titration to detect hyper- and hypoglycemia from rapid infusion changes; (2) sterile hub disinfection (scrub the hub) and shift-by-shift insertion-site assessment for CLABSI prevention; (3) air embolism precautions and immediate response (left lateral Trendelenburg); (5) daily weight, I/O, and electrolyte tracking for refeeding syndrome (hypophosphatemia, hypokalemia, hypomagnesemia). Choice 2 is incorrect — TPN should run through a dedicated lumen because compatibility and infection risk make co-infusion and same-lumen draws unsafe.
TPN metabolic complications include hyperglycemia and hypoglycemia from rapid initiation or cessation, refeeding syndrome (hypophosphatemia, hypokalemia, hypomagnesemia in chronically malnourished patients), hepatic dysfunction with prolonged use, and electrolyte and acid-base imbalances. Daily glucose, electrolytes, weight, and I/O are essential during the first week. CLABSI prevention bundle includes scrubbing the hub at every access, a dedicated lumen for TPN, sterile technique for dressing changes, daily review of line necessity, and chlorhexidine site preparation; CLABSI is a never event with mortality up to 25 percent. Air embolism presents as sudden chest pain, dyspnea, hypoxia, hypotension, and a mill-wheel murmur; the response is to clamp the catheter, place the patient in left lateral Trendelenburg (which traps air in the right atrium), administer 100 percent oxygen, and notify the provider. Prevention includes trapping air out of tubing, securing connections, and Valsalva or supine positioning during line manipulation.
A patient with short bowel syndrome is receiving TPN through a PICC. The nurse plans assessments and interventions to detect and prevent complications.
TPN Metabolic Complications — Hyperglycemia and hypoglycemia (rapid initiation/cessation), refeeding syndrome (hypophosphatemia, hypokalemia, hypomagnesemia in chronically malnourished), hepatic dysfunction with prolonged use, electrolyte and acid-base imbalances. Daily glucose, electrolytes, weight, I/O during the first week.
CLABSI Prevention — Central line-associated bloodstream infection prevention bundle: scrub the hub at every access, dedicated lumen for TPN, sterile technique for dressing changes, daily review of line necessity, chlorhexidine site prep. CLABSI is a never event with mortality up to 25 percent.
Air Embolism — Sudden chest pain, dyspnea, hypoxia, hypotension, mill-wheel murmur in the patient with central venous access. Action: clamp the catheter, place patient in left lateral Trendelenburg (traps air in right atrium), administer 100 percent oxygen, notify provider. Prevention: trap air in tubing, secure connections, Valsalva or supine position during line manipulation.