Nutrition - Parenteral: Nursing skills

There are many reasons why a client might encounter problems with eating or drinking. It could be due to difficulties with chewing, swallowing, or digestion as a result of trauma, surgery, or various medical conditions. Several alternative methods of providing them the nutrients and fluids they need are available. As the nurse, you will be responsible for the care of a client receiving these alternative delivery methods including parenteral nutrition. Now, parenteral nutrition is a kind of liquid nutrition that is infused intravenously to prevent malnutrition. Each client’s parenteral nutrition is individualized based on their unique nutritional needs and is prepared in the pharmacy. There are two primary types of parenteral nutrition: total parenteral nutrition, or TPN, and peripheral parenteral nutrition, or PPN.

TPN is delivered through a central line, which has a catheter that’s inserted into a large vein near the heart like the superior vena cava. It is used for clients who cannot handle any food in their gastrointestinal tract. This could be due to gastrointestinal trauma; surgical procedures; or various disorders, like cancer or inflammation. In these cases, all nutrients are delivered, including carbohydrates, amino acids, lipids, vitamins, minerals, and water.

PPN, on the other hand, is less calorie dense and can be administered through a peripheral intravenous line. It is used when a client does not have a central line or if they only need parenteral nutrition for less than 10 to 14 days. The length of time a client gets PPN should be limited because after 10 days, clients receiving PPN have a much higher risk of complications like infection or inflammation of the vein, called phlebitis. To help avoid this, you should rotate the PPN infusion site every 48 to 72 hours and check catheter patency regularly according to your facility’s protocol.

So, when your client has an order for parenteral nutrition there are steps to take to keep your client safe. You should follow the same steps for safely administering medications, and identify your client using at least two identifiers such as name and medical record number. Remember that parenteral nutrition is mixed for each client’s individual nutritional needs and so one bag of parenteral nutrition is not the same as another. Next, compare the bag label with the provider’s order to make sure it contains the right nutritional mixture. Then, check the bag for any obvious punctures or leaks, inspect the contents of the bag for any particles or clumps, and check to make sure the contents of the bag haven’t separated into layers. If the bag is damaged or the solution is clumped or layered, notify the pharmacy so a new bag can be prepared.

Okay, when preparing to administer parenteral nutrition, collect your supplies, perform hand hygiene, and apply clean gloves. Inspect the intravenous access site by looking for signs of inflammation like swelling, redness, or warmth in the surrounding tissues, and make sure the dressing is intact and secure.

Next, invert the bag and spike tubing fit with an appropriate micron filter. A micron filter will remove any microscopic particles and prevent them from infusing into the bloodstream. Once the bag is spiked, prime the line by running the solution through the IV tubing to expel any air bubbles, and then clamp the line to keep the bag from emptying. Then, hang the bag on the IV pole and insert the tubing into the IV pump and set the infusion rate according to the provider’s order.

Before attaching the IV tubing to the client’s peripheral IV or central line access site, use your facility-approved antimicrobial solution to scrub the IV access port, and allow it to air dry. Next, take a 10 mL saline-filled syringe, and connect it to the IV access port. Unclamp the tubing, and gently aspirate, checking for blood return. If the line is patent, there will be a brisk return of blood. Then, you can gently flush the line with about 5 mL of the saline. When flushing, the client should not report pain, no swelling should occur at the site, and resistance should not be felt. After flushing, reclamp the tubing, disconnect the saline syringe, and discard it.