A nurse discovers the TPN bag is empty 1 hour before the nex… | MyMerci
Adverse Effects/Contraindications/InteractionsPPT
Question
A nurse discovers the TPN bag is empty 1 hour before the next bag is due. Which action is most appropriate?
1Switch immediately to enteral feeds
2Push concentrated dextrose IV
3Hang D10W (or D5W if D10 unavailable) at the same rate to prevent rebound hypoglycemia, monitor blood glucose, and notify pharmacy for the next bag✓ Correct answer
4Disconnect the IV and wait
Explanation
Correct (2): TPN has high glucose load; abrupt discontinuation → rebound hypoglycemia from endogenous insulin still circulating. Hang D10W (preferred) or D5W at the same rate until new TPN available; monitor glucose. Also taper TPN gradually when planned discontinuation (over 1-2 hours). (1,3,4) Wrong.
In-depth explanation
Memory Tip TPN abrupt stop = "Rebound HYPOglycemia." Hang D10 bridge. Plan taper for elective discontinuation. Same line — do NOT piggyback other meds with TPN.
Clinical scenario
Scenario Adult on continuous central TPN; bag empty 1 hour early. Next TPN bag not yet available from pharmacy.
Key concepts
TPN abrupt discontinuation — Risk of rebound hypoglycemia; bridge with D10W and monitor glucose.
TPN taper — Gradual reduction over 1-2 hours when discontinuing electively.
TPN dedicated line — TPN requires dedicated line; do not piggyback medications or draw blood.