# 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. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=372752&lang=en > language: en > subject: Adverse Effects/Contraindications/Interactions > category: PA ## Question 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. 1 Assess for signs of air embolism — sudden chest pain, dyspnea, hypoxia, hypotension — and place the patient in left lateral Trendelenburg if suspected. 2 Administer TPN through the same lumen used for intermittent medications, flushing thoroughly before and after, to maintain a single access site. 3 Monitor blood glucose every 4–6 hours during initiation and titration to detect hyper- and hypoglycemia. 4 Track daily weight, intake/output, and serum phosphate, potassium, magnesium during the first week to recognize refeeding syndrome. 5 Use scrupulous sterile technique with hub disinfection at every line access and inspect the insertion site each shift for redness, drainage, or tenderness. ## 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. ## In-depth explanation 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. ## Clinical scenario A patient with **short bowel syndrome** is receiving **TPN through a PICC**. The nurse plans assessments and interventions to detect and prevent complications. ## Key concepts - **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. ## Related questions - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=en) - [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=en) - [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. 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