INFUSING TOTAL

PARENTERAL NUTRITION
(TPN)
DEFINITION
Total Parenteral Nutrition (TPN) – formerly called
hyperalimentation, the intravenous infusion of a
solution containing dextrose, amimo acids, fats,
essential fatty acids, vitamins and minerals through a
central venous catheter usually inserted into the
superior vena cava.
Peripheral Parenteral Nutrition (PPN) – is the
intravenous administration of nutritionally balanced
isotonic or mildly hypertonic solutions via a peripheral
vessel, used for short term (3 weeks or less). It cannot
handle as concentrated a solution as central lines but
can accommodate lipids.
RATIONALE
TPN formulas are used for client’s who, because of their disease
process or treatment, are unable to receive adequate nutrition
through the gastrointestinal tract. The following are examples of
disease states that require this type of nutritional intervention:
 
Short bowel syndrome
Inflammatory bowel disease
Gastrointestinal fistula
Hypermetabolic state (severe burns)
Intractable diarrhea
Serious acute alimentary disease (pseudomembranous colitis)
Chronic idiopathic intestinal pseudo-obstruction
Renal or hepatic failure
EQUIPMENT
TPN solution Adhesive Timing Tape

Infusion Pump Tubing with filter

Disposable gloves IV infusion tubing

PLANNING AND IMPLEMENTATION
Confirm the order for TPN

Obtain vital signs, including recent body temperature,

client’s weight, fluid balance, and any allergy to
contents of the TPN solution.
 PLANNING AND IMPLEMENTATION
Inspect and prepare the solution. * Remove the ordered TPN solution
from the refrigerator 1 hour before use,
and check each ingredient and the
proposed rate against the order on the
chart.
* Inspect the solution for cloudiness or
presence of particles, and ensure that the
container is free from cracks.
* For lipids, examine the bag for
separation of emulsion, fat globules, or
froth.
* Check its expiration date. Most
solutions must be used within 24 hours
of preparation, unless they are
refrigerated.
* Two licensed nurses need to check the
nutrients in the bag with the order
written by the doctor.
* Apply a timing tape on the solution
PLANNING AND IMPLEMENTATION
Explain the procedure to the
client.

Assist the client to a comfortable

position, either sitting or lying.

Perform hand hygiene and

observe appropriate infection
control procedures.
PLANNING AND IMPLEMENTATION
Using aseptic technique, change the solution container
to the TPN solution ordered. 2. Ensure that the tubing
has an in-line filter
1. Ensure that correct connected to the end of the
placement of the central TPN tubing.
line Plain TPN – 0.22
catheter has been micron filter
confirmed by x-ray TPN with lipids – 1.2
examination. microns filter
Plain lipids – without
filter
4. Attach
3. Attach the TPN solution
and
to the IV administration
connect
tubing. If a multiple-lumen
the
tube is in place, attach the
tubing to
infusion to the appropriate
an
lumen. If possible, a lumen
infusion
should be dedicated to TPN
pump.
use only.
PLANNING AND IMPLEMENTATION
Regulate and monitor the flow rate based on client’s
nutritional and metabolic needs.

•Establish the prescribed rate of flow

•Never accelerate an infusion that has
fallen behind schedule.
•Never interrupt or discontinue the
infusion abruptly.
•Closely monitor vital signs and side
effects (e.g., fever, flushing, diaphoresis,
dyspnea, cyanosis, headache, nausea or
vomiting)
•Start lipid infusions very slowly
PLANNING AND IMPLEMENTATION
Monitor the client for complications.
•Change the administration set and filter
every 24 hours.
•Monitor vital signs every 4 hours. If fever
or abnormal vital signs occur, notify the
primary care giver.
•Assess fingerstick blood glucose levels
every 6 hours according to agency
protocol.
•For hyperglycemia supplementary insulin
may be ordered subcutaneously or added
directly to the TPN solution per doctor’s
order.
•For hypoglycemia the infusion rate may
need to be increased.
Measure the daily fluid intake and output
and calorie intake.
PLANNING AND IMPLEMENTATION
Wash hands.

Assess weight. Weigh the client daily at the same time.

EVALUATION
Monitor the client’s response hourly, assessing for
complications such as allergic reactions, fluid
overload, occlusion of the line, and electrolyte
imbalance (mental status changes)
Monitor blood glucose frequently per facility routines.
Monitor electrolytes.
Monitor weight daily and intake and output.
 DOCUMENTATION
Initiation of therapy
Type and amount of infusion and rate of infusion.
Vital signs every 4 hours.
Fingerstick blood glucose levels as ordered.
Client’s daily weight
TPN ADMINISTRATION
PREPARATION VIDEO

https://www.youtube.com/watch?v=57tdifh4Wn8