What should I monitor for total parenteral nutrition?
A multidisciplinary approach to the management of patients receiving TPN is recommended to reduce complications, writes Deirdre McCormack Show Total parenteral nutrition is the aseptic delivery of nutrients into the circulatory system via a central venous catheter or the peripheral veins. TPN is used when the gut is not functioning and there are several indications that may suggest its use (see Table 1).
Access routes and duration Central vein cannulation is the most commonly used route, however peripheral feeding is an acceptable alternative for short-term feeding. A single dedicated lumen should be used for administration of TPN. Nutritional assessment A baseline biochemical assessment should identify any abnormal plasma electrolyte levels, liver function tests, renal function tests, glucose levels or lipid screen. Nutritional requirements Fluid Acute changes in fluid can also be determined by monitoring acute changes in biochemical parameters such as albumin, haemoglobin, mean cell volume, urea and sodium. To maintain fluid levels, the following is required:
Plus replacement of ongoing fluid losses, eg. pyrexia, urine, drains, excess wound exudates, stomas and high GI losses. Energy It is imperative that these equations are not used in isolation and that monitoring of the patient occurs to assess efficacy. Indirect calorimetry may be used. However, this is not practical in the acute setting. Nutritional requirements are also affected by medical conditions, thus alternate evidence based predictive equations exist for certain conditions such as liver disease, renal failure and the critically ill obese. Nitrogen The aim of nutritional support is to achieve a state of nitrogen balance using nitrogen balance data where available or general recommendations.2 The nitrogen in parenteral nutrition is provided in the form of an amINO acid solution. Electrolytes
Vitamins and trace elements
Monitoring Patients receiving TPN should have their nutritional requirements reviewed regularly, taking into account clinical condition, treatments (eg. dialysis), drug therapy, nutritional status, response to TPN and supporting laboratory data. Clinical assessment of the patient can reveal ascites, oedema, impaired wound healing or loss of muscle mass that may not be evident from monitoring weight and biochemical indices (see Table 2).
Complications
Standard versus tailored regimens Patients on TPN that are metabolically stable can tolerate slight under or over provision of nutrients, fluid or electrolytes with no complications. It is the careful assessment that will identify those patients who are likely to be substrate intolerant and require frequent manipulations or specifically tailored regimens. Albumin Novel substrates After injury/hypercatabolic conditions, profound intracellular glutamine depletion has been found, thus is regarded as a conditionally essential amINO acid. Studies have shown improvements in the clinical outcome of hypermetabolic patients. Optimal
management Deirdre Mc Cormack is a clinical nutritionist at St. James's Hospital Dublin References on request. All rights reserved by INMO. Please don't use without permission What lab values do you monitor with TPN administration?The following blood values are monitored; sodium, potassium, chloride, CO 2 content, BUN, creatinine, blood sugar, calcium, magnesium, phosphorus, hemoglobin, hematocrit and white blood cell count. Other additional blood tests may also be needed to monitor you while you receive TPN.
What is the most common complication of parenteral nutrition?Fatty liver is the most common complication, whereas intrahepatic cholestasis or hepatitis are less frequent.
What is the nurse's responsibilities in administering TPN?Educate client on the need for and use of TPN. Apply knowledge of nursing procedures and psychomotor skills when caring for a client receiving TPN. Apply knowledge of client pathophysiology and mathematics to TPN interventions. Administer parenteral nutrition and evaluate client response (e.g., TPN)
What are 3 complications associated with parenteral nutrition?Complications Associated with Total Parenteral Nutrition
Dehydration and electrolyte Imbalances. Thrombosis (blood clots) Hyperglycemia (high blood sugars) Hypoglycemia (low blood sugars)
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