NCLEX-RNPharmacological and Parenteral TherapiesMedium
A client is receiving total parenteral nutrition (TPN) via a central venous catheter. The nurse notes that the TPN bag is empty and the new bag is not yet available from the pharmacy. What is the most appropriate immediate nursing action?
- AConnect a bag of Dextrose 10% in Water (D10W) to the TPN line.
- BFlush the TPN line with heparinized saline.
- CConnect a bag of 0.9% Normal Saline to the TPN line.
- DNotify the healthcare provider and wait for further orders.
Show answer & explanationAnswer & explanation
Correct answer: A. Connect a bag of Dextrose 10% in Water (D10W) to the TPN line.
TPN solutions are hypertonic and contain high concentrations of dextrose. Abrupt cessation can lead to rebound hypoglycemia. Administering Dextrose 10% in Water (D10W) at the TPN rate prevents hypoglycemia until the next TPN bag is available. Normal saline does not contain dextrose and would not prevent hypoglycemia.
Why the other options are wrong
- B. Flushing with heparinized saline is for maintaining line patency, not for preventing metabolic complications from TPN cessation.
- C. 0.9% Normal Saline does not contain glucose and would not prevent hypoglycemia.
- D. While the provider should be notified, an immediate action is required to prevent a serious complication like hypoglycemia.
TPN Interruption Management
Abrupt cessation of Total Parenteral Nutrition (TPN) can cause rebound hypoglycemia due to the body's continued high insulin production. Administering Dextrose 10% in Water (D10W) prevents this complication.
- TPN is hypertonic and glucose-rich.
- Pancreas continues insulin production after TPN stops.
- D10W provides temporary glucose support.
- Never abruptly stop TPN if new bag is not ready.
Memory trick: TPN is Done? Give D10W, Don't Drop the Glucose!