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NU 122 lab TPN

John Anderson

on 8 April 2015

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Transcript of TPN, LIPIDS, AND CVDA'S

John Anderson, MS, RN
Fats that are sometimes added to TPN
Most people need 10% of their diet to be fats
Given with TPN to decrees microorganism growth
Hang at room temp
Check VS every 30 mintuse for one hour
Change tubing with filter and TPN every 24 hours, because of bacteria
can't catch up
Can not run anything with TPN except Lipids
Ramp up and ramp down
Used for long term replacement therapy
Medication administration
Nutritional supplementation
Bloods draws
Dacron is placed in the tunnel. Promotes scar tissue which prevent the migration of the catheter
Placed in the O.R.
No dressing needed after inc. is healed
impregnated with silver
last months to years
Tunneled Catheters
Clamped when not in uses
Clean and hold- do not drop
Flush with 10ml of NS
Flush and clamp catheter before removing syring. this maintains positive pressure so blood will not back up
Hickman and Broviac
No clamp or heparin needed
Saline only, may need up to 20ml post TPN or blood products
Change port after each blood draw or if not in use every week
Used a lot with Chemo clients
Candidate for TPN
Comatose clients
non-function GI system
Surgical clients
Clients receiving Chemo
Multiple Fracture
Any illness or injury that requires increase nutrients
Total Parenteral Nutrition
Highly concentrated Hypertonic Solution
Consisted of Carbs, Proteins, and Fats ( when Lipids are added)
Will be mixed in the pharmacy. No longer can you add anything to the TPN bag
PPN- Peripheral Parenteral Nutrition-not as concentrated
If there is not any TPN on the floor call the MD ans ask to run Dextrose (D10) until the TPN is available
liver function
S/S of infection
BUN and Creat
Weight and I&O'S
S/S of decrease absorption
When there is too much glucose then bacterial will grow, resulting in the client becoming septic
If you can not flush the line use the SAS method.
S- Saline
A- Administer/withdraw
S- Saline
or try
Reposition the client
Cough and deep breath
place arm over their head
Stop/Start push/Pause

Need two 10ml syringes of NS
Draw up 0.5ml of blood, stop for 2 seconds, then draw up 5ml of blood
This will be your wast
Do this for every syringe
This creates turbulence/swirling effect and prevents occlusion
Tape catheter to client
Avoid straight pull and kinking
Do not use scissors around any catheter
You can cut the catheter and the catheter will go inside of the body and the client will have to go to the OR TO GET IT REMOVED.
Can last for years
lowest infection rate of all CVAD'S
If not used flush every 30 days to maintain patency
Uses a needle called Huber
Use sterile gloves

Placed by MD or special trained RN
Basilic vein preferred
Used for
Long term up to a year
Less risk because placed in the arm then to the vena cava
Can be placed in the hospital or at the client home
If placed in the hospital then it will be a central line and needs to have have a x-ray to confirm placement
If placed in home then it's a medial IV. No x-ray needed
Occludes because of long small lumen
Frequent flushing
No BP or blood draws in the same arm
Change dressing every week and PRN
Full transcript