HOME TPN INFUSION 2

Paloma home health agency and artex present an inservice for our nurses for teaching patients receiving TPN infusions in the home.
The client/caregiver can define total parenteral nutrition or hyper alimentation.
A. It is a hypertonic solution consisting of dextrose, amino acids, lipids, and select electrolytes and minerals. It is given through a central line to provide all nutrients for the body.
B. The solution is a sterile mixture that is prepared by a pharmacist.
C. The client will need to be monitored by ongoing assessments and laboratory testing.
II. The client/caregiver can list possible reasons for receiving total parental nutrition therapy.
A. Reduced intake of calories because of
1. Inability to absorb or digest food (i.e., severe vomiting or diarrhea, obstruction, severe burns, trauma, and cancer)
B. Prolonged alteration in gastrointestinal function because of
1. Disease, requiring the bowel or other organs to rest (pancreatitis, severe inflammatory bowel disease, etc.)
C. Weight loss of 10% or more of usual body weight
D. Reduction in values for
• Prealbumin
• Serum albumin
• Total lymphocyte count
• Total iron-binding capacity
E. Intolerance to food or enteric feedings
III. The client/caregiver can demonstrate how to care for TPN solution.
A. Keep TPN solution in refrigerator.
B. Take next bag of solution from the refrigerator 4 to 6 hours before using, and allow solution to reach room temperature before using.
C. Keep supplies in a clean, dry place.
D. Keep solution away from children.
E. Check solution bag before use.
1. Solution should be clear and free of floating material. If lipids are added, the solution may appear milky but free of floating material.
2. Make sure that the bag has no leaks or damage.
3. Make sure that the bag is labeled with contents and expiration date.
IV. The client/caregiver can demonstrate the administration of the solution.
A. Clean work area. Wash hands. Assemble equipment.
B. Read the label carefully to be sure that it is exactly what the physician prescribed.
C. Inspect solution and warm solution to room temperature.
D. Prepare solution and tubing as instructed.
E. Set the pump to infuse solution at the rate ordered by physician.
F. Flush the catheter as ordered when solution is finished.
V. The client/caregiver can list general care measures to prevent complications.
A. Prevent infection by using strict technique as instructed.
B. Inspect catheter insertion site daily for signs of redness, warmth, swelling, or drainage.
C. Monitor for fluid overload by checking for any swelling in arms, legs, hands, and so forth.
D. Weigh at the same time every day.
E. Check urine for glucose and acetone as ordered.
F. Provide good oral care frequently.
G. Change dressing as ordered.
H. Flush catheter as ordered.
I. Take temperature as ordered.
J. Use your solution exactly as directed.
K. Have contact numbers for physician, pharmacist, nurse, and any other health care provider available to call if problems or questions occur.
L. It is important to keep all appointments with your doctor and the laboratory.
VI. The client/caregiver can list signs and symptoms of complications when receiving TPN.
A. Report these side effects if they are severe or do not go away:
• Mouth sores
• Poor night vision
• Skin changes
B. Call physician or health care provider if any of the following symptoms occur:
• Fever or chills
• Stomach pain
• Difficulty breathing
• Rapid weight gain or loss
• Increased urination
• Upset stomach or vomiting
• Confusion or memory loss
• Muscle weakness, twitching, or cramps
• Swelling of hands, feet, or legs
• Extreme thirst
• Fatigue
• Changes in heartbeat
• Tingling in the hands or feet
• Convulsion or seizures
C. Call if there is a catheter occlusion or partial occlusion: lack of flow or decreased flow of solution.