Comprehensive Guide to our TPN Infusion Care
Introduction
Total Parenteral Nutrition (TPN) is a life-sustaining therapy that provides essential nutrients directly into the bloodstream when a patient cannot receive adequate nutrition orally or enterally. TPN is typically administered through a central venous catheter (CVC) and requires strict aseptic technique, continuous monitoring, and specialized care to prevent complications.
1. Indications for TPN
TPN is used when a patient’s gastrointestinal tract is non-functional or cannot meet nutritional needs. Common indications include:
- Gastrointestinal disorders (e.g., Crohn’s disease, bowel obstruction, short bowel syndrome)
- Severe malabsorption syndromes
- Prolonged NPO status (>7 days)
- Post-surgical patients with impaired gut function
- Severe burns or trauma
- Cancer patients undergoing chemotherapy/radiation with severe mucositis
- Hyperemesis gravidarum (persistent vomiting during pregnancy)
2. TPN Components
A TPN solution contains:
A. Macronutrients
- Carbohydrates (Dextrose – primary energy source)
- Proteins (Amino acids for tissue repair and growth)
- Fats (Lipids) (Essential fatty acids for energy and cell function)
B. Micronutrients
- Electrolytes (Sodium, potassium, calcium, magnesium, phosphorus)
- Vitamins (A, B-complex, C, D, E, K)
- Trace elements (Zinc, copper, selenium, manganese)
C. Fluids
- Water for hydration
- Additional medications (e.g., insulin for glucose control, heparin to prevent clotting)
3. TPN Administration
A. Route of Administration
TPN is infused via:
- Central Venous Catheter (CVC): Preferred for long-term TPN
- Peripherally Inserted Central Catheter (PICC line)
- Tunneled Catheters (Hickman, Broviac, Groshong)
- Implanted Ports
- Peripheral Parenteral Nutrition (PPN): Used for short-term, lower concentration solutions
B. Aseptic Technique & Infection Control
- Perform hand hygiene and wear sterile gloves.
- Use sterile dressing changes for central lines.
- Disinfect catheter ports before accessing.
- Monitor for signs of infection (redness, swelling, fever, drainage at insertion site).
4. Nursing Responsibilities
A. TPN Preparation & Administration
- Verify physician orders and TPN composition.
- Check expiration date and solution clarity.
- Use an electronic infusion pump to maintain a controlled flow rate.
- Start infusion slowly to prevent metabolic complications.
- Ensure lipid emulsions are infused separately if prescribed.
B. Monitoring During TPN Infusion
- Vital signs (Monitor temperature for infection, blood pressure for fluid overload).
- Blood glucose levels (Every 4-6 hours to detect hyperglycemia or hypoglycemia).
- Daily weight measurements (Assess fluid balance and nutritional status).
- Intake and output (I&O) monitoring (Detect fluid overload or dehydration).
- Signs of complications (infection, thrombosis, hyperglycemia, electrolyte imbalance).
C. Catheter Care & Maintenance
- Flush the catheter with saline or heparin as per protocol.
- Change TPN tubing every 24 hours to prevent infection.
- Inspect the catheter site daily for redness, swelling, or leakage.
- Avoid blood draws from the same lumen as TPN to reduce contamination risk.
5. Potential Complications & Nursing Interventions
| Complication | Signs & Symptoms | Nursing Interventions |
|---|---|---|
| Infection (Sepsis/Central Line-Associated Bloodstream Infection – CLABSI) | Fever, chills, increased WBC, redness/swelling at insertion site | Strict aseptic technique, monitor for signs, obtain blood cultures if suspected |
| Hyperglycemia | Increased thirst, frequent urination, high blood glucose levels | Monitor glucose regularly, administer insulin if needed |
| Hypoglycemia | Sweating, confusion, shakiness, low blood glucose levels | If TPN is stopped suddenly, administer dextrose IV |
| Electrolyte Imbalances | Muscle cramps, confusion, irregular heartbeat | Monitor labs, adjust TPN components as needed |
| Refeeding Syndrome | Low phosphate, potassium, magnesium; fluid retention | Start TPN slowly, monitor electrolytes closely |
| Fluid Overload | Swelling, shortness of breath, increased BP | Monitor I&O, adjust fluid intake, assess lung sounds |
6. Patient & Family Education
- Explain the purpose of TPN and potential complications.
- Teach catheter care and infection prevention measures.
- Discuss symptoms of complications and when to seek medical help.
- Emphasize compliance with prescribed therapy for optimal outcomes.
7. Discontinuing TPN
- Gradually wean off TPN to prevent hypoglycemia.
- Monitor oral/enteral intake to ensure adequate nutrition.
- Assess weight and lab values before discontinuation.
TPN infusion nursing care requires meticulous monitoring, infection prevention, and patient education to ensure safe and effective therapy. Our nurses follow best practices in managing TPN patients and improving their overall health outcomes.