TPN A.

TPN- total parenteral nutrition- delivery nutrition through large bore veins when GI delivery not possible 1. Subclavian or jugular 2. Start gradually 40-60mL to avoid hyperglycemia- pancreas needs time adjust insulin output B. METHODS DELIVERY 1. Central venous access i. CVC ii. PICC iii. High calorie, high protein needs 2. Peripheral venous access i. Cephalic or basilic veins ii. Lower calorie & protein needs, supplement oral intake, central access to risky C. NURSING INTERVENTIONS 1. Assess VS q4-8hrs 2. Daily weight 3. Monitor labs: blood glucose (q406hrs), BUN, creatinine, e-lytes, CBC w/ WBC, hepatic enzymes 4. I/O 5. Assess infection 6. Change dressing & tubing 7. Assess re-feeding syndrome 8. Monitor flow rate &volume 9. Assess complications 10. Assess cardiac status 11. Ass s/s over-hydration D. COMPLICATIONS 1. Infection 2. Metabolic probs: hyperglycemia, hypoglycemia, hyperlipidemia, fluid volume overload, prerenal azotemia, e-lyte imbalance, essential fatty acid & vit. Deficiency 3. Mechanical problems: catheter insertionair embolism, pneumothorax, hemothorax, chylothorax, pyrothorax, hemorrage 4. Dislodgement 5. Thrombosis of vein 6. phlebitis