THE CLIENT RECEIVING
PARENTERAL NUTRITION
Parenteral nutrition
is the provision of nutrients intravenously. It is used if the gastrointestinal
tract is not functional or if normal feeding is not adequate for the client’s
needs. It can be used alone or as part of a dietary plan that includes oral or
tube feeding as well. When parenteral nutrition is used to provide total
nutrition, it is called total parenteral nutrition (TPN) or hyperalimentation.
Nutrient solutions are
prescribed by the physician and dietitian and are prepared by a pharmacist.
They can be administered via a central vein or, for a period of 2 weeks or
less, a peripheral vein. Typically, a
dextrose–amino acid–fat solution is given. This solution is not combined until
just before entry into the vein because the components do not form a stable
solution.
Total parenteral
nutrition that is required for an extended period is provided via a central
vein. A catheter is surgically inserted, under sterile conditions, by a
physician. It is inserted into a subclavian vein or the superior vena cava. The
vena cava is used because the high blood flow there facilitates the quick
dilution of the highly concentrated TPN solution. Dilution reduces the
possibility of phlebitis and thrombosis.
When parenteral
nutrition is no longer necessary, the client must be transferred gradually to
an oral diet. Sometimes clients are given tube feeding before oral feeding as
they are weaned from TPN.
Infection can occur at
the site of the catheter and enter the bloodstream, causing an infection of the
blood called sepsis. Bacterial or fungal
infections can develop in the solution if it is unrefrigerated for over 24
hours. Abnormal electrolyte levels may develop, as can phlebitis or blood
clots. Careful monitoring of the client is essential.
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