{
  "name": "Total Parenteral Nutrition",
  "slug": "total-parenteral-nutrition",
  "url": "https://nursingplex.com/care-plans/total-parenteral-nutrition",
  "category": "Basic Nursing & General Care Plans",
  "summary": "IV nutrition through a central line; nursing centers on glucose control, line sepsis prevention and fluid balance.",
  "nursing_diagnoses": [
    "Risk for infection",
    "Risk for unstable blood glucose",
    "Imbalanced nutrition"
  ],
  "overview": [
    "Total parenteral nutrition delivers complete nutrition — dextrose, amino acids, lipids, electrolytes, vitamins and trace elements — directly into the bloodstream when the gastrointestinal tract cannot be used or cannot absorb enough. Because of its high dextrose concentration, TPN requires a central venous access device.",
    "The therapy carries three principal dangers: catheter-related bloodstream infection, metabolic derangement (hyperglycemia, hypoglycemia on abrupt discontinuation, electrolyte shifts) and refeeding syndrome in severely malnourished patients, where insulin surges drive phosphate, potassium and magnesium into cells.",
    "Nursing care is protocol-driven: strict aseptic line care, precise infusion rate control, frequent glucose and electrolyte monitoring, and daily reassessment of whether enteral feeding can be resumed."
  ],
  "key_facts": [
    {
      "label": "Access",
      "text": "TPN with dextrose above roughly 10% must run through a central line; peripheral PN is only for short-term, lower-concentration use."
    },
    {
      "label": "Never abruptly stop",
      "text": "Taper the rate or hang dextrose 10% to prevent rebound hypoglycemia."
    },
    {
      "label": "Refeeding syndrome",
      "text": "Start low and advance slowly in malnourished patients; watch phosphate, potassium and magnesium closely."
    },
    {
      "label": "Line rules",
      "text": "Use a dedicated lumen, change tubing every 24 hours for lipid-containing solutions, and never bolus or 'catch up' a delayed infusion."
    }
  ],
  "nursing_priorities": [
    "Prevent catheter-related bloodstream infection.",
    "Maintain stable glucose and electrolyte balance.",
    "Deliver prescribed calories and protein to reverse malnutrition.",
    "Detect refeeding syndrome early.",
    "Transition to enteral or oral nutrition as soon as the gut is usable."
  ],
  "assessment": {
    "subjective": [
      "Reports of weakness, poor appetite or recent weight loss",
      "Complaints of thirst, frequent urination or nausea",
      "Concerns about body image, tubing and dependence on the pump"
    ],
    "objective": [
      "Baseline and daily weights, intake and output",
      "Blood glucose trends and insulin requirement",
      "Electrolytes, phosphate, magnesium, prealbumin, triglycerides and liver enzymes",
      "Catheter exit site redness, drainage or tenderness; fever or chills",
      "Signs of fluid overload: edema, crackles, rising weight"
    ],
    "related_factors": [
      "Bowel obstruction, short bowel syndrome, severe inflammatory bowel disease",
      "Prolonged ileus, high-output fistula or pancreatitis",
      "Severe malnutrition with a non-functional GI tract",
      "Central venous catheter as a portal of entry for organisms"
    ]
  },
  "goals": [
    "The client will remain free from catheter-related infection.",
    "The client will maintain blood glucose within the ordered range.",
    "The client will maintain or gain weight toward the nutritional goal.",
    "The client will maintain electrolytes within normal limits."
  ],
  "interventions": [
    {
      "title": "Infection prevention",
      "points": [
        "Use sterile technique for all line access, dressing changes and tubing changes.",
        "Scrub the hub for at least 15 seconds before every access; keep the TPN lumen dedicated.",
        "Inspect the exit site each shift and change the dressing per protocol or when soiled.",
        "Report fever, chills or new leukocytosis immediately and obtain cultures as ordered."
      ]
    },
    {
      "title": "Safe administration",
      "points": [
        "Verify the bag against the order with two nurses, including additives and rate.",
        "Infuse via a volumetric pump with a filter; refrigerate bags and warm to room temperature before hanging.",
        "Hang each bag no longer than 24 hours; never speed up or slow down to compensate for timing.",
        "Taper the rate when discontinuing and monitor glucose afterward."
      ]
    },
    {
      "title": "Metabolic monitoring",
      "points": [
        "Check capillary glucose every 4–6 hours initially and give sliding-scale insulin as ordered.",
        "Monitor daily weights, strict intake and output, and daily electrolytes early in therapy.",
        "Watch phosphate, potassium and magnesium for refeeding syndrome during the first week.",
        "Assess for fluid overload, hepatic dysfunction and elevated triglycerides.",
        "Advocate for enteral feeding trials whenever bowel function returns."
      ]
    }
  ],
  "patient_teaching": [
    "Explain the purpose of TPN, the pump alarms and why the line must stay sterile.",
    "For home TPN, teach hand hygiene, aseptic connection, glucose checks and signs of infection.",
    "Advise reporting fever, shaking chills, swelling at the site or unusual thirst.",
    "Encourage oral care and mobility even while NPO."
  ]
}