TPN
What is TPN?
Total Parenteral Nutrition- intravenous infusion of amino acids, carbohydrates, fats, electrolytes, vitamins, and minerals.
Another name for Lipids
Fat Emulsions
Two uses for NG tubes.
Tube feedings and suction to remove abdominal pressure/contents
Another name for tube feedings
Enteral nutrition
Difference between secondary infusion vs. Y site infusion
secondary- above pump, higher than primary bag, infuses first, then primary bag continues
Y site- connect below pump, usually has its own pump, infuses simultaneously
Reasons a patient would require TPN
Trauma, surgery, unable to get nutrition from oral consumption or Enteral feeding
Complication of Lipid infusion
Hyperlipidemia
Confirmation of NG placement
Initailly X-ray, Mark or line on tubing, aspiration of contents- check Ph.
Reasons a patient would require tube feedings.
unresponsive, intubated, difficulty swallowing, neck or oral surgery, anorexia, trauma, GI tract impairment
What is back priming?
When you hold the secondary bag below the primary to allow the fluid from the primary bag to flow into the tubing connecting the secondary bag
True or False: TPN can administered by calculating the drip rate if a pump is unavailable.
False- A pump is necessary to ensure the correct rate of infusion.
How Lipids are administered and why?
intermittently- allowing the body to clear the fats from the blood (to avoid pt from developing hyperlipidemia)
What is the external tube length used for?
Knowing if the tube is still in the right place
Tube feedings can be administered through these types of tubes.
Nasogastric, Nasojejunal (nasoduodenal), gastrostomy, jejunostomy
You are getting bedside report and the nurse states she just hung a new bag of TPN an hour ago. The patient is complaining of new headache, nausea. You check the TPN rate and notice it is going at three times the ordered rate. What is the first step you take and why?
Stop the TPN- pt is hyperosmolar
What puts people receiving TPN at high risk for infection?
Disruption of the skin, at the IV site, and infusion high in glucose. This can be local or systemic.
Set-up of IV tubing
Y-port or Y site piggyback
Head position while inserting NG.
Neutral or forward
Aspiration and Diarrhea
Ways to administer tube feedings
Gravity, bolus, or continuous through pump
Other complications of TPN
glucose tolerance, metabolic acidosis, fluid overload, and dehydration
Important nursing assessments while patients are receiving TPN & Lipids
Daily weight, glucose, temperature, Intake & Output, CBC, BMP, liver studies, signs of infection
Your patient is admitted for a bowel obstruction, an NG is placed in the ED, placement is confirmed via X-ray and they are sent to the floor. You attach your patient to LIS, but then the MD orders some medications to be given. What do you do about the NG?
Turn off suction or clamp for 20-30 minutes after medication administration.
Important nursing assessments while patients are receiving tube feedings
tube placement, residual, HOB, site, intake and output, fluid status
How often should you change the tubing for TPN and tube feedings?