Patients who have severe burns, gastrointestinal (GI) tract disorders, acquired immunodeficiency syndrome (AIDS), or a debilitating disease will most often receive an infusion of nutrients. This means of administering nutritional support is called parenteral nutrition.
Parenteral nutrition involves administering a solution that contains glucose, amino acids, vitamins, electrolytes, minerals, and trace elements through a central venous line such as the subclavin or internal jugular vein. These veins are primarily used to prevent irritation to the peripheral veins. In some instances, a patient who needs to increase his or her caloric intake or fat-soluble vitamins will be given fat emulsion supplemental therapy.
A catheter must be inserted for this type of nutritional support therapy. The nurse will monitor the patient for any signs of complication that can arise from the inserted catheter or the infusion of the feeding. The complications that can arise from the catheter are pneumothorax, hemothorax, and hydrothorax. The complications that can arise from parental nutrition infusion are air embolisms, infection, hyperglycemia, hypoglycemia, and fluid overload.
The nurse should special care to ensure that gloves and masks be used whenever the IV tubing or the dressing at the infusion site is changed. Parenteral nutrition solutions can easily harbor yeast and bacteria if they are not carefully cleaned and changed regularly.
A patient may develop hyperglycemia from the initial introduction of parenteral nutrition support because the pancrease has not had time to adjust to the hypertonic dextrose solution that is infused. This type of solution is very high in glucose and can be overwhelming to the pancreas initially. A patient undergoing parenteral nutrition should be monitored carefully for hyperglycemia. Sometimes a patient will develop temporary hyperglycemia which will dissipate as soon as the pancreas adjusts to the infusions. The best way to prevent hypoglycemia from occurring is to use a slow infusion rate. It is best to start with 1 liter of solution for the first 24 hours and increase from 500 to 1000 mL each day until a daily volume of 2500 mL to 3000 mL is reached.
The patients tubing and solution should be changed every 24 hours and the patients dressing should between 48 and 72 hours or according to the facility policy.