Monitoring Nutritional Status

Table 11.2 provides a comprehensive guide to the relevant monitoring required when a patient is receiving TPN. In particular the nurse should be alert to the possible complications of TPN.

Table 11.2 Parenteral nutrition – relevant monitoring

Reproduced by permission of Butterworth Heinemann Elsevier, from Bersten and Soni (2009).

Monitoring	Specific tasks
Regular clinical	Temperature Blood pressure Pulse rate Respiratory rate Fluid balance Blood glucose (4-hourly when commencing feed)
Daily (at least)	Fluid balance review Nutrient intake review Urea, electrolytes and creatinine Blood glucose
Weekly (at least)	Full blood count Coagulation screen Weight Liver functions tests Serum calcium/magnesium/phosphate
As indicated	Zinc Uric acid

During TPN administration, there is a significant risk of morbidity through sepsis, metabolic and mechanical problems (Sabol and Steele 2009; Ziegler 2009). Mechanical complications include: pneumothorax, bleeding, thrombus formation, sepsis; catheter related, metabolic; overfeeding (excess dextrose, fat, calories and re-feeding syndrome (rapid feeding of patients with pre-existing malnutrition) (Ziegler 2009). In addition, rebound hypoglycaemia can occur if the TPN infusions are abruptly stopped. Regular urinalysis and blood glucose monitoring are therefore important.

The function of the gut should be monitored so that conversion to enteral nutrition can be initiated as soon as possible. TPN should be gradually withdrawn in order to avoid complications, e.g. rebound hypoglycaemia. In some instances and enteral and concomitant parenteral feeding may be necessary to meet metabolic demands.

Best Practice – Parenteral Feeding

Only use when enteral route is not possible

Do not use feed bag if there are signs of contamination

Administer feed following local protocols

Ensure that entire infusion line is dedicated to parenteral nutritional use

Ensure that feed and tubing are regularly changed (usually every 24 hours)

Never add anything to a bag of TPN

Monitor patient’s blood chemistry

Monitor blood sugar 2-hourly when first initiated

Monitor patient for complications of parenteral nutrition, particularly infection

Regularly flush line when not in use to maintain patency

Avoid breaks in circuit