Patients with paralyzed or nonfunctional GI tract, or conditions that require bowel rest, such as small bowel obstruction, ulcerative colitis, or pancreatitis.
Describe refeeding syndrome and state one method to reduce the risk of refeeding syndrome. Next: 8. Share This Book Share on Twitter. Rationale and Interventions. CR-BSI, which starts at the hub connection, is the spread of bacteria through the bloodstream. Symptoms include tachycardia, hypotension, elevated or decreased temperature, increased breathing, decreased urine output, and disorientation.
Due to poor aseptic technique during insertion, care, or maintenance of central line or peripheral line Interventions: Apply strict aseptic technique during insertion, care, and maintenance. A pneumothorax occurs when the tip of the catheter enters the pleural space during insertion, causing the lung to collapse.
An air embolism may occur if IV tubing disconnects and is open to air, or if part of catheter system is open or removed without being clamped. Related to sudden increase in glucose after recent malnourished state. Refeeding syndrome is caused by rapid refeeding after a period of malnutrition, which leads to metabolic and hormonal changes characterized by electrolyte shifts decreased phosphate, magnesium, and potassium in serum levels that may lead to widespread cellular dysfunction.
Signs and symptoms include fine crackles in lower lung fields or throughout lung fields, hypoxia decreased O 2 sats. Additional Information. Intravenous line should remain patent, free from infection. Monitor for evidence of edema or fluid overload.
QID 4 times a day capillary blood glucose initially to monitor glycemic control, then reduce monitoring when blood sugars are stable or as per agency policy. Monitor and record every eight hours or as per agency policy. Review lab values for increases and decreases out of normal range.
Most patients will be NPO. Vital signs are more frequently monitored initially in patients with TPN. Disclaimer: Always review and follow your hospital policy regarding this specific skill. Use strict aseptic technique when caring for central venous catheters and PICC lines. Do not use TPN solution if it has coalesced, as evidenced by formation of a thick, dense layer of fat droplets on its surface. If the solution appears abnormal in any way, request a replacement from the pharmacy.
Never try to catch up with a delayed infusion. Medications may be added to the TPN. Ensure tubing is primed correctly to prevent air embolism. TPN tubing with special filter. Explain the procedure to the patient. Hand hygiene prevents the spread of microorganisms. Proper identification prevents patient errors. Compare MAR to patient wristband. Complete all safety checks for CVC as per agency policy. Some people report a quality of life on parenteral nutrition similar to that of receiving dialysis.
Fatigue is common in people receiving home parenteral nutrition. Total parenteral nutrition care at Mayo Clinic. Mayo Clinic does not endorse companies or products.
Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Parenteral nutrition, often called total parenteral nutrition, is the medical term for infusing a specialized form of food through a vein intravenously. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Longo DL, et al. Enteral and parenteral nutrition therapy. In: Harrison's Principles of Internal Medicine.
Typically, TPN requires a solution of water 30 to 40mL , energy 30 to 45kcal , amino acids, essential fatty acids 1 to 2kg , vitamins and minerals. For instance, patients with heart or kidney disorders may require a limited volume of liquid intake while those with respiratory failure require a liquid emulsion that provides most of the nonprotein calories.
The basic daily requirements for total parenteral nutrition information can be found in the Merck Manual. TPN is also highly common among children and teenagers. Children who are on TPN may have short bowel syndrome, which results from the malfunctioning of the small intestine and other intestinal diseases like microvillus inclusion disease. TPN is not only used for young children but is also commonly used for teenagers.
However, being on TPN may be most difficult mentally for teenagers since they are highly concerned about their body image. Hence, it may be especially helpful for teens to get in contact with other teens who are also on TPN by joining support groups. For instance, teenagers and their caregivers can join The Oley Foundation , a national, non-profit organization that provides information, services, and emotional support for people on TPN, their families, and caregivers.
First, TPN is administered through a needle or catheter that is placed in a large vein that goes directly to the heart called a central venous catheter. Since the central venous catheter needs to remain in place to prevent further complications, TPN must be administered in a clean and sterile environment.
For instance, external tubing should be changed every day and dressings should be kept sterile with replacement every two days. TPN is usually used for 10 to 12 hours a day, five to seven times a week. Most TPN patients administer the TPN infusion on a pump during the night for hours so that they are free of administering pumps during the day. TPN can also be used in both the hospital or at home. However, if TPN is given at home, it is crucial for patients to be given a qualified home nurse in order to better recognize various symptoms of an infection and be taught the correct steps of administering the nutrition.
For example, patients must store their prescribed liquid in a refrigerator and remove each dose from the fridge about five minutes before use. It is also important that progress be followed and monitored by an interdisciplinary nutrition team.
In particular, plasma glucose should be monitored every 6 hours until patients and glucose levels become stable. Also, other measurements including liver function tests and full nutritional assessments including BMI calculation and Anthropometric measurements should be repeated at 2 weeks intervals. TPN is beneficial because it provides nutrients that are vital in maintaining high energy, hydration and strength levels.
Also, it will allow patients to heal more quickly and feel more energized. It is especially beneficial for children and teenagers because if these two groups do not get all of the nutrients they need, then they may have developmental or growth delays. However, there are also many risks associated with receiving TPN. The most common risk includes catheter infection with the most serious form resulting in sepsis.
Foe example, it may be more difficult for your child to go to a sleepover. Although TPN does change things, it is not and should not be the end of a normal routine and normal activity for you or your child.
There will be disruptions, but with the help and support of your home infusion company and the Intestinal Care Center, you should try to minimize them as much as possible.
Maintaining a sense of normalcy is important for both you and your child, no matter how old he or she is. While your child is on TPN, he or she can do many, if not most, of the same things that other children of the same age can do.
Many limitations will depend on why your child needs TPN- or on his or her underlying disease or problem - and its affect on how well your child feels in general. As long as your child feels well, encourage him or her to stay as active as possible and to continue doing normal activities for his or her age. Activities to avoid are swimming and contact sports. Things like soccer, gymnastics, baseball, and riding bikes are safe and may be fun for your child.
If you ever have any doubts or questions about the safety of participating in an activity, be sure to call your nurse at the Intestinal Care Center. Being on TPN may be the most difficult mentally for teenagers. They may be more concerned about their body image and being able to live a "normal" teenage life. They may disconnect their TPN before they should or sometimes not do it at all. It is important to try to recognize if this is happening so you can address the problem with the help of the Intestinal Care Center.
It may be especially helpful for teens to get in contact with other kids who are on TPN. IT may also be helpful for you to get in touch with other families who have a child on TPN.
The nutrition support team can help you get in touch with other parents and children who are on TPN and who may be dealing with and going through the same things you are.
There are also support groups available for families and the children who are on TPN. The Oley Foundation is on such example. The Oley foundation is a national, non-profit organization. It provides information, outreach services, and emotional support for persons on TPN, their families and caregivers. Before your child leaves the hospital after being put on TPN, a clinical nurse specialist or educator in nutrition support will give you detailed instructions and help you prepare for returning home.
He or she will teach you how to administer TPN, how to take care of the equipment, how to recognize a problem and what to do in case of an emergency. Depending on your child's age, he or she may also may be involved in the learning process. The more involved your child is, the better.
Taking an active role in treatment can help your child feel like he or she has some control over his or her medical condition. Your child may be more likely to comply with instructions and medications if he or she is involved and active in his or her own care. The time when your child first goes on TPN will probably be the most difficult as you learn a new routine, and how to take care of your child's TPN needs.
You may have trouble at first and become easily frustrated. Just like with anything, as time goes on and with practice, total parenteral nutrition will probably get easier for both you and your child. It will just become another part of your family's daily routine.
Once you and your child return home from the hospital, you will usually do your child's TPN infusion at night while he or she is sleeping.
This will minimize daily disruption and your child will not have to deal with tubes and pumps during the day. Remember to call your home infusion company or the Intestinal Care Center with any questions, doubt, worries, problems, or concerns.
They are there to help you and your child. It is important to be able to recognize the signs ans symptoms of infection. Before your child leaves the hospital on TPN, you will learn what the signs and symptoms of infection are.
Call your child's clinical nurse specialist or doctor immediately if he or she has a fever or experiences any of the following at their catheter site:. TPN increases the risk of having liver disease and damage. Infants and yound child on TPN are more at risk for liver disease than older children and adults. The organs of infants and younger children are still developing. They are not as capable of handling the burden and strain that TPN puts on them.
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