Instructions

Take Another Course

Post-Test

Glossary

Team approaches that assess, prescribe, monitor, and provide ongoing treatment are essential to successful therapy. Both prevention efforts and early identification of complications are important to achieve the best clinical outcomes.

Usage guidelines of parenteral nutrition support in both institutional and outpatient settings have been established and are modified as new information and research-based evidence contributes to refined practice. [8] [9] [10] [11] [12] [13] The prevention and prompt treatment for complications of TPN can significantly reduce morbidity and mortality. Routine monitoring and trouble shooting of medical conditions, parenteral solutions, and methods of administration are essential to safety and efficacy in the homecare setting.

The most common complications of parenteral nutrition are infections, followed by mechanical and metabolic problems. Metabolic complications may occur in between 5-10% of adults receiving the therapy. Fluid Overload, intolerances and toxic reactions, and deficiencies of nutrients have all been documented and require care and treatment by clinicians who are knowledgeable about the prevention, identification, and treatment strategies for adverse metabolic effects.

Early complications are typically preventable. Early complications may include volume overload, hyperglycemia, acidosis and refeeding syndrome, with accompanying lower levels of potassium, phosphate and magnesium. Later complications may include the exacerbation of existing conditions and unanticipated long-term deficiencies of vitamins, minerals and essential fatty acids. Fatty liver, cholestasis and metabolic bone disease may be late complications

Careful monitoring of patients for complications is essential for prevention and treatment efforts. Table 1 shows some variables that should be monitored often during the initiation of TPN as the desired rate and concentration of formulation is achieved. Once the patient is stable, monitoring can occur less often. However, if the patient becomes metabolically unstable, more frequent monitoring should resume.

Table 1. Monitoring Criteria*

Monitor

Baseline

Initial Frequency/Acute Patient

Stabilized Frequency

Weight

X

Daily

Weekly or 2-3 times/week

Electrolytes

X

Daily

Monthly

Blood urea nitrogen

X

Daily

Monthly

Calcium, phosphorus, magnesium

 

Daily

Monthly

Glucose

X

Daily (more often if at high risk) until stabilized <200 mg/dL

2-3 times/week

Triglycerides

X

Weekly

Weekly

Liver function tests

X

Biweekly

Weekly

Hemoglobin/hematocrit

X

Weekly

 

Prothrombin Time, Partial Thromboplastin Time

X

Weekly

Weekly

Clinical status

X

Daily

Daily

Catheter site

X

Daily

Daily

Temperature

 

Daily

Daily

Input and output

 

Daily

Daily

*Monitoring frequency recommendations vary; see specific recommendations for institution or home care agency

----------------------------

[8] ASPEN. Administration of specialized nutrition support. J Parenter Enteral Nutr. 2002;26(1 suppl):18SA-21SA.

[9] ASPEN. Administration of specialized nutrition support - issues unique to pediatrics. J Parenter Enteral Nutr. 2002;26(1 suppl):97SA-110SA.

[10] Report on the guidelines on parenteral nutrition in infants, children and adolescents. Clin Nutr. 2005;24(6):1105-1109.

[11] ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr. 2002;26(1 suppl):1SA-138SA.

[12] Mirhosseini N, Fainsinger RL, Bacacos V. Parenteral nutrition in advanced cancer: indications and clinical practice guidelines. J Palliative Med. 2005;8(5):914-918.

[13] Guidelines for management of home parenteral support in adult chronic intestinal failure patients. Gastroenterology. 2006;130(2 suppl 1):S43-S51.

 

Click on the link at left to go to your desired page:  Page 1  Page 2  Page 3  Page 4  Page 5  Page 6  Page 7  Page 8  Page 9  Page 10  Page 11  Page 12  Post-Test

Continue

Implications for social workers

2006 Hi-R-Ed Online University. All courses posted on this site are the property of Hi-R-Ed Online University unless otherwise stated. Courses may not be copied or transferred in electronic, printed, or other forms, or modified for any purpose without explicit written consent of Hi-R-Ed Online University.