NCLEX-PN® ExaminationReduction of Risk PotentialHard
A client is receiving total parenteral nutrition (TPN) through a central venous catheter. The LPN notes that the TPN bag is empty, and the new bag is not yet available from the pharmacy. The client's next TPN bag is expected in 30 minutes. What is the most appropriate action for the LPN to take?
- AFlush the central line with heparin to maintain patency.
- BInfuse 0.9% 20% dextrose in water (D20W) until the new TPN bag arrives.
- CInfuse 10% dextrose in water (D10W) at the prescribed TPN rate.
- DDiscontinue the central venous catheter until the new TPN is ready.
Show answer & explanationAnswer & explanation
Correct answer: C. Infuse 10% dextrose in water (D10W) at the prescribed TPN rate.
TPN solutions contain high concentrations of dextrose. Abruptly stopping TPN can lead to rebound hypoglycemia. Infusing D10W (10% dextrose in water) at the same rate as the TPN provides a temporary source of glucose, preventing hypoglycemia while waiting for the new TPN bag. D20W would be too concentrated.
Why the other options are wrong
- A. Flushing with heparin maintains patency but does not prevent rebound hypoglycemia, which is a significant risk with TPN discontinuation.
- B. D20W is too concentrated and could cause hyperglycemia or osmotic diuresis; D10W is the standard temporary solution.
- D. Discontinuing the central line is inappropriate as it's still needed for TPN and would require another invasive procedure to re-establish access.
TPN Interruption Management
Protocols for managing temporary interruptions in total parenteral nutrition (TPN) administration to prevent complications like rebound hypoglycemia.
- Abrupt cessation of TPN can cause rebound hypoglycemia
- D10W (10% dextrose in water) is the standard temporary replacement solution
- Should be infused at the same rate as the TPN
Memory trick: TPN Stop? D10W Drop!