Table 1 Complications of Parenteral Nutrition
Complication Possible Cause
Air embolism  Catheter system opened
or IV tubing disconnected
 Air entry on IV tubing
changes
Hyperglycemia  High concentration of
dextrose in solution
 Client receiving solution
too quickly
 Not enough insulin
 Infection
Hypervolemia  Excessive fluid
administration or
administration of fluid too
rapidly
 Renal dysfunction
 Heart failure
 Hepatic failure
Hypoglycemia  PN abruptly discontinued
 Too much insulin being
administered
Infection  Poor aseptic technique
 Catheter contamination
 Contamination of solution
Signs or Symptoms
 Apprehension
 Chest pain
 Dyspnea
 Hypotension
 Loud churning sound
heard over pericardium
on auscultation
 Rapid and weak pulse
Respiratory distress
 Restlessness
 Confusion
 Weakness
 Diaphoresis
 Elevated blood glucose
level > 200 mg/dL (10.9
mmol/L)
 Excessive thirst
 Fatigue
 Kussmaul respirations
 Coma (severe)
 Bounding pulse
 Crackles on lung
auscultation
 Headache
 Increased blood
pressure
 Jugular vein distention
 Weight gain greater
than desired
 Anxiety
 Diaphoresis
 Hunger
 Low blood glucose level
<70 mg/dL (<3.9
mmol/L)
 shakiness
 weakness
 Chills
 Fever
 Elevated White blood
cell count
 Redness or drainage at
the insertion site
Intervention
 Clamp all ports of IV
catheter
 Place client in a left
side-lying position with
the head lower than
the feet
 Administer Oxygen
 Notify Physician
 Notify HCP
 The infusion rate may
need to be slowed
 Monitor blood glucose
levels
 Administer regular
insulin as prescribed
 Slow or stop IV
infusion.
 Notify the PHCP
 Restrict the fluids
 Administer diuretics as
prescribed
 Use dialysis as
prescribed (in extreme
cases)
 Notify the PHCP
 Administer IV dextrose
 Monitor blood glucose
level
 Notify the PHCP
 Remove catheter
 Send catheter tip to
the laboratory for
culture
 Prepare to obtain
blood cultures
Prevention
 Make sure all catheter
connections are secure (use
tape per agency protocol)
 Clamp the catheter when not
in use and when changing
caps (follow agency protocol
for flushing and clamping the
catheter and cap changes)
 Instruct the client in the
Valsalva maneuver for tubing
and cap changes
 For tubing and cap changes,
place the client in the
Tredelenburg position (if not
contraindicated) with the
head turned in the opposite
direction of the insertion site,
client should hold breath and
bear down
 Assess client for history of
glucose intolerance
 Assess the client’s
medication history
(corticosteroids increase
blood glucose).
 Begin infusion at a slow rate
as prescribed (usually 40-60
mL/hr)
 Monitor blood glucose levels
on agency protocol
 Administer regular insulin as
prescribed
 Use strict aseptic technique
to prevent infection
 Assess the client’s history for
risk for hypervolemia
 Administer via an electronic
infusion device, and ensure
proper function of the device.
 Never increase the rate of
infusion device to “catch up”
if the infusion gets behind
 Monitor intake and output
 Monitor weight daily (ideal
weight gain is 1-2 lb per
week)
 Gradually decrease solution
when discontinued
 Infuse 10% dextrose at same
route as the PN to prevent
hypoglycemia for 1-2 hours
after the PN solution is
discontinued
 Monitor glucose levels and
check the level 1 hour after
discontinuing the PN.
 Use strict aseptic techniques
(PN solution has a higher
concentration of glucose and
is a medium for bacterial
growth).
 Monitor temperature (fever
could indicate infection).

Pneumothorax  Inexact catheter  Chest or shoulder pain
placement resulting in  Sudden shortness of
puncture of the pleural breath
space  Cyanosis
 Tachycardia
 Absence of breath
sounds on affected side
 Prepare for antibiotic  Assess IV site for signs of
administration infection (redness, welling,
drainage).
 Change site dressing,
solution and tubing as
specified by agency policy
 Do not disconnect tubing
unnecessarily.
 Notify the PHCP  Monitor for signs of
 Prepare to obtain pneumothorax
chest x-ray  Obtain a chest x-ray after
 Small pneumothorax insertion of the catheter
may resolve placement
 Large pneumothorax  PN is not initiated until
may require chest correct catheter placement is
tube verified and the absence of
pneumothorax is confirmed