1. Parenteral Nutrition By Dr. Hanan Said Ali

2. Objectives. Define parenteral nutrition. Explain how to prepare the patient. Explain how administer parenteral nutrition.. Demonstrate the care of patient with a parenteral nutrition. Identify complications of it.

3. Parenteral Nutrition It has two forms:  Total Parenteral nutrition Is the intravenous infusion of water, protein, carbohydrates, electrolytes, minerals and vitamins through a central vein.  Peripheral Parenteral nutrition Delivered into the smaller peripheral veins, cannot handle as concentrated a solution ( maximum 10% dextrose).

7. Parenteral Nutrition  Dextrose, amino acids, electrolytes, vitamins, and minerals are mixed together in one container and infused as the primary TPN solution.  Lipid emulsions containing primarily essential fatty acids are administered from a separate container through a Y- connector into the TPN intravenous line.

8. Parenteral Nutrition Complications of TPN  Significant changes occurs in the client's fluid, electrolyte, glucose, amino acid, vitamin, and mineral levels.  Hyperglycemia, hypoglycemia, acidosis.  Electrolyte deficiency or excesses such as hyprekalaemia, hyponatremia, and hypocalcemia

9. Parenteral Nutrition Patient Preparation  Gather the patient data. Know the purpose of the TPN.  Confirm the physician” order for the TPN.  Obtain vital signs, including recent body temprature; client” weight; fluid balance; and any allergy to content of the TPN solutions.

10. Parenteral Nutrition Equipment  TPN solution  Timing tape  Infusion pump  Tubing with filter

11. Parenteral Nutrition Preparation  Inspect and prepare the solution  Remove the ordered TPN solution from the refrigerator 1 hour before use, and check the proposed rate.  (cold cause pain, hypothermia, and venous spasm and constriction)  Inspect the solution for cloudiness or presence of particles.

12. Parenteral Nutrition Preparation Cont.  Check the expiration date, it must be used within 24 hours of preparation. Performance  Explain the procedure.  Provide the client privacy.  Prepare the client:  Check the client”s identification band.  Assisst the client to a comfortable position.

13. Parenteral Nutrition Performance  Wash hands  Observe appropriate infection control procedures.  Change the solution container to the TPN solution ordered.  Ensure that correct placement of the central line catheter by x- ray.  Ensure that the tubing has an in- line filter connected at the end of the TPN tubing.

14. Parenteral Nutrition Performance  Attach and connect the tubing on an infusion pump.  Attach the TPN solution to the IV administration tubing.  Regulate and monitor the flow rate.  Establish the prescribed rate of flow and monitor the infusion at least every 30 minutes.  Never accelerate an infusion that has fallen behind schedule ( Wide fluctuations in blood glucose can occur if the rate of TPN infusion is irregular)

15. Parenteral Nutrition Performance  Never interrupt or discontinue the infusion abruptly.  ( if TPN solution is temporarily unavailable, infuse a solution containing at least 5 percent dextrose. This prevents rebound hypoglycaemia)  Closely monitor vital signs, and signs of any side effects at the first hour ( fever, flushing, diaphoresis, dyspnea, cyanosis, headache, nausea, or vomiting)

16. Parenteral Nutrition  Start lipid infusions very slowly according to the physician's orders.  Monitor the client for complications:  Change the administration set and filter every 24 hours.  Monitor the vital signs every 4 hours ( an elevated temp. Indicate catheter – related sepsis)  Collect double- voided urine specimens to test the specific gravity, if it abnormal, notify the physician, who may alter the constituents of the TPN solution

17. Parenteral Nutrition  Assess finger stick blood glucose levels every 6 hours.  Measure the daily fluid intake and output and calorie intake.  Monitor the results of laboratory test and report abnormal findings.

18. Parenteral Nutrition  Assess weight and anthropometric measurements:  Weigh the client daily, at the same time and in the same garments ( a gain of more than 0.5 kg per day indicates fluid excess and should be reported).  Measure arm circumference and triceps skinfold thickness weekly.

19. Parenteral Nutrition  Document all relevant information:  Type and amount of infusion.  Rate of infusion.  Vital signs q 4h.  Fingerstick blood glucose levels.  Client's weight daily.  Anthropometric measurements.

20. Thank You