1. Verify central line placement after initial insertion via chest (radiograph) prior to beginning TPN infusion; pneumothorax or hemothorax is a risk with central line placement.
2. Check vital signs (including blood pressure) at least every 6 hours after initiating infusion.
3. Check central line insertion site frequently for signs of infection (infection is a common complication when a central line is used and may lead to sepsis).
4. Follow agency policy regarding frequency of dressing changes and procedure.
5. Change IV line setup every 24 hours. (TPN fluids are an excellent medium for bacterial growth.)
6. Do not administer IV piggyback or direct IV push medications through or draw blood samples from the TPN line. Only lipids may be “piggybacked” carefully through the TPN line beyond the in-line filter.
7. Monitor blood glucose every 6 hours; administer sliding scale insulin as ordered.
8. Weigh patient daily. (High glucose content of TPN can cause an osmotic diuresis and lead to dehydration.)
9. Order TPN solutions from the pharmacy in a timely manner; remove the next container from the refrigerator an hour before needed to prevent central infusion of cold solutions.
10. When a new container of TPN is needed, but is not available, follow agency policy to maintain the ordered fluid delivery rate with D10W until the TPN is available. (High glucose content of fluid stimulates release of insulin, which may cause hypoglycemia if fluids are discontinued abruptly.)
11. Do not attempt to “catch up” on fluids if rate inadvertently slows.
12. Discontinue TPN solution gradually at the end of therapy to prevent hypoglycemia.
13. Monitor lab values. (Liver complications, electrolyte imbalances, and pH changes are possible.)