A client is receiving total parenteral nutrition (TPN) via a central venous catheter. The nurse notes the TPN bag is nearly empty, and the new bag is not yet available from the pharmacy. The client's blood glucose is 180 mg/dL. Which action should the nurse take?
- AAdminister a bolus of D5W through a peripheral IV port.
- BNotify the provider that the TPN will be interrupted.
- CHang a bag of 10% dextrose in water (D10W) at the current TPN rate.
- DFlush the central line with normal saline and wait for the new TPN bag.
Show answer & explanationAnswer & explanation
Correct answer: C. Hang a bag of 10% dextrose in water (D10W) at the current TPN rate.
TPN contains a high concentration of dextrose, and abrupt discontinuation can lead to rebound hypoglycemia. To prevent this, if a new TPN bag is not available, a D10W (10% dextrose in water) infusion should be initiated at the same rate as the TPN. The client's current blood glucose of 180 mg/dL is elevated, but this does not negate the risk of subsequent hypoglycemia upon TPN cessation.
Why the other options are wrong
- A. Administering D5W (5% dextrose) is typically not concentrated enough to prevent rebound hypoglycemia after TPN discontinuation. It also requires a separate peripheral IV, which may not be available or ideal.
- B. Notifying the provider is important, but it does not address the immediate physiological need to prevent hypoglycemia. The nurse should act first and then inform.
- D. Flushing with normal saline will not prevent rebound hypoglycemia once the TPN is discontinued.
TPN Discontinuation & Hypoglycemia
Total Parenteral Nutrition (TPN) provides concentrated glucose. Abrupt cessation can cause rebound hypoglycemia due to continued insulin production by the pancreas. To prevent this, a temporary infusion of 10% dextrose in water (D10W) should be initiated at the TPN rate until the next TPN bag is available.
- TPN contains high dextrose.
- Abrupt stop causes rebound hypoglycemia.
- D10W prevents hypoglycemia.
- Maintain current infusion rate.
Memory trick: TPN's gone? D10W comes on!