TPN Administration Checklist.pdf

TPN Administration Checklist

Step (C)

Completed

Correctly

(I)

Completed

Incorrectly

(N)

Not

Complete

Verbalize that you would:

oRead order for TPN

oGather supplies

oKnock on the patient door

oProtect privacy

oComplete hand hygiene

oIntroduce yourself

oIdentify patient

oAssess for allergies

Explain procedure to patient.

Position patient comfortably for procedure.

Perform hand hygiene and apply clean gloves.

Perform the 6 rights of medication administration.

Perform the three checks to ensure the TPN matches the order.

Verify TPN order with another RN before administering

Explain the use and possible side effects of medications.

Inspect the TPN solution to be sure it is particle free and has not

separated into layers

Connect TPN to appropriate tubing with filter

Prime the tubing

Place tubing in an infusion pump

Set the rate, volume to be infused (VTBI) as ordered and select

TPN from the drug library on the pump

After the pump has been set, scrub the hub for at least 30

seconds.

Connect the tubing to the central line

Recheck the VTBI and rate. Once verified, start the infusion

Remove gloves after perform hand hygiene.

Ensure patient is in comfortable position with bed locked and

low, call bell in reach.

Document

TPN/Lipids:

Any written order by the physician for TPN covers the subsequent 24-hour period

All solutions are prepared per physician order and nothing may be added to the line or bottle

Any STAT changes are called to the pharmacy and they revise the formula to be delivered

If an increase in flow rate is ordered, the increased rate will begin the following 24-hour interval.

This avoids bottles running out when the pharmacy is not available.

TPN must be tapered if discontinued.

TPN must be infused through a central line.

Lipids can be infused with TPN but must be run below the filter.

Lipids must be refrigerated 1 hour before administration

Ensure the use of a filter with TPN tubing and change with each bottle.

Do not add anything to the intralipid solution

Adverse reactions to lipids can include allergic reaction, dyspnea, cyanosis, fever, flushing, and

phlebitis.

Things to monitor:

Daily weights, assessing for fluid retention

Glucose and electrolytes

Inspect and maintain central line site

Unexpected Outcomes:

Redness, swelling around the central line insertion site

Occlusion of the central line

Weight gain greater than 1 lb per day

Crackles auscultated over the lung fields

Taut skin turgor

Serum electrolytes or glucose out of range

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