These patients receive an infusion of a solution that contains hyperosmolar
glucose, amino acids, vitamins, electrolytes, minerals, and trace elements. In
addition, the patient might be given fat emulsion supplemental therapy to
increase the number of calories and to receive fat-soluble vitamins. The infusion
is given through a central venous line such as the subclavian or internal jugular
vein to prevent irritation to the peripheral veins.
The nurse must monitor the patient for signs of complications as a result of
inserting the catheter and the infusion of the feeding.
Catheter insertion can cause
- Pneumothorax.
- Hemothorax.
- Hydrothorax.
Parental nutrition infusion can cause:- Air embolism.
- Infection.
- Hyperglycemia.
- Hypoglycemia.
- Fluid overload.
It is important that strict asepsis (gloves and masks) be used when changing
the IV tubing and the dressing at the infusion site because parenteral nutrition
solutions are an excellent medium for yeast and bacteria to grow. The pharmacy
uses a laminar airflow hood when preparing parenteral nutritional solutions to
reduce this risk.
Monitor the patient carefully for hyperglycemia when you initiate parenteral
nutrition support because the pancreas needs time to adjust to the hypertonic
dextrose solution, which is high in glucose. Sometimes hyperglycemia is tem-
porary and dissipates once the pancreas makes the necessary adjustments.
However, hyperglycemia might persist if the infusion rate is too fast. To pre-
vent this from occurring, begin with 1 liter of solution for the first 24 hours.
Increase this by 500 to 1000 mL each day until you reach a daily volume of
2500 mL to 3000 mL.
Change the solution and tubing every 24 hours. Change the dressing every 48
to 72 hours or according to the agency policy.
Caution: Don’t suddenly interrupt parenteral nutrition support because the
patient can experience hypoglycemia. Discontinue gradually by decreasing
the infusion rate. However, hypoglycemia may occur in spite these precautions.
CHAPTER 11 Nutritional Support Therapies^191