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.