TPN: Risks & Side Effects

Instructor: Justine Fritzel

Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.

TPN is intravenous nutrition used when no other option for nutrition is available. In this lesson, we will learn about TPN along with its possible complications.

TPN

Sharon was driving home late last night when an oncoming car crossed into her lane. She swerved to avoid a head-on collision and rolled her car, landing in a ditch. The airbag went off and probably saved her life, but she was taken to the hospital with very serious injuries. She had several broken bones, as well as abdominal injuries that required emergency surgery. She is now out of surgery and in the ICU facing a long recovery. She is awake but hooked up to all kinds of wires and monitors. She has a couple different bags of IV fluids hanging. Due to her abdominal injuries, she is unable to eat or drink anything by mouth. The nurses explain to her that she is receiving nutrition through her IV until she is able to eat and drink again.

Sharon is receiving total parenteral nutrition (TPN). TPN provides the essential nutrients when the gastrointestinal tract is not functioning correctly. TPN contains glucose, amino acids, lipids, vitamins, and minerals - in fact, it provides all of the daily nutritional requirements.

TPN is administered intravenously, meaning in the veins. TPN is hyperosmolar, meaning it is very concentrated. It has to be given through a central line, an intravenous line that has the tip in the superior vena cava, because TPN could cause a blood clot if given in smaller peripheral veins.

Intravenous nutrition should only be used when there are no other options for nutritional intake. Receiving nutrition via the gastrointestinal tract is always preferred, whether that means eating or getting nutrition through a feeding tube. TPN doesn't engage the GI tract to work to help maintain it's natural structure and function.

TPN is administered in healthcare settings and can also be used at home, administered by a registered nurse. TPN requires close monitoring, including all kinds of lab tests that vary in frequency from multiple times a day to every once every couple of weeks. As you can see, TPN is not to be taken lightly. It is a very serious intervention that requires a competent team to oversee its use.

Risks

Three of the most common complications with the use of TPN include infection, abnormal glucose levels, and liver dysfunction.

Central line placement is a risky procedure in itself. Complications can include puncturing a major artery or vein or the lung. Heart arrhythmias can also occur during placement. There is a high risk of infection due to having an intravenous line in place. Placement and care of a central line requires the use of strict sterile technique to decrease the risk of infection.

Due to the presence of glucose (sugars) in TPN, the use of TPN can affect the glucose levels in the blood. It could cause hyperglycemia (high blood glucose levels) or hypoglycemia (low blood glucose levels). Insulin is naturally produced by our bodies to prevent high blood glucose levels, but additional insulin is necessary with TPN. Insulin is added into the TPN solution, and frequent blood glucose levels are monitored to determine if additional insulin is needed via injection. If TPN is suddenly stopped, the high glucose intake is stopped and could result in a low blood glucose level. It is important to maintain normal blood glucose levels.

TPN administration can also result in liver problems. Lab results would indicate if the liver is not functioning as well as it should be. Sometimes,TPN can even cause an enlarged, painful liver called hepatomegaly. Another liver complication can be elevated levels of ammonia in the body, called hyperammonemia.

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