PARENTERAL NUTRITION (PN)

REQUIREMENTS #

1. Central venous access devices
2. Volume control device
3. Filters (0.22 micron for TPN without fat emulsion and 3.2 micron filter for TNA or fat emulsion
4. Bag of Parenteral Nutrition
5. Administration tubing with luer-lock connections
6. Hypoallergic Tape
7. Sterile Gloves
8. Face Mask
9. Gown and cap
10. Vital Signs Tray

STEPS #

1. Perform nutritional assessment
2. Cross check physician’s order
3. Provide Privacy
4. Establish rapport with patient
5. Explain procedure to the patient and obtain consent
6. Perform hand hygiene
7. Collect needed items for the procedure
8. Review prescribers’ orders and compare to content label on PN solution bag(s) and for rate of infusion. Each component of the PN solution must be verified with the physician’s orders
9. Remove the bag of parenteral nutrition at least 1 hr. from the refrigerator if refrigerated
10. Inspect fluid for consistency(creamy, or any change in constitution)
11. Collect supplies, prepare PN solution, and prime IV tubing with filter as per hospital’s protocol
12. Perform hand hygiene, done gown, cap, mask and gloves
13. Compare the label on the PN bag to the patient’s wristband
14. Use aseptic technique to attach tubing with filter to TNA bag and purge out air
15. Close all clamps on new tubing and insert tubing in volume control infuses
16. Place patient in supine position and turn head away from venous access device insertion site
17. Clean insertion site with povidone iodine solution
18. Assist physician while inserting intravenous line
19. Connect tubing to hub of VAD after insertion using sterile technique and ensure all connections are locked with luer-connection
20. Complete all safety checks for central venous catheter as per hospital’s policy
21. Complete the flushing protocol as per hospital’s policy
22. Sanitize connections and change IV tubing as per agency policy when changing tubing
23. Insert new PN solution and IV tubing into electronic infusion device
24. Open all clamps and regulate flow using volume control infuser
25. Start PN infusion rate as ordered
26. Discard old supplies as per agency protocol, and perform hand hygiene
27. Monitor administration hourly; assessing for integrity of fluid, administration system, patient tolerance and other symptoms of complications related to PN
28. Document the procedure in the patient chart as per hospital policy