A nurse is caring for a client who has a prescription for total parental nutrition (TPN).
Which of the following routes of administration should the nurse use?
A.
Central venous access device.
B.
Midline catheter.
C.
Subcutaneous.
D.
Intraosseous.
The Correct Answer and Explanation is:
The correct answer is:
A. Central venous access device.
Explanation:
Total Parenteral Nutrition (TPN) is a method of feeding that bypasses the digestive tract. It provides nutrients directly into the bloodstream through a central vein. Due to its composition, which includes a high concentration of glucose, amino acids, lipids, and electrolytes, TPN requires a route that can handle its hypertonic nature and avoid complications such as thrombosis or infection.
Here’s a breakdown of why a central venous access device is the appropriate route:
- High Osmolarity: TPN solutions are hypertonic because of their high glucose and nutrient concentrations. Central veins, such as the superior vena cava, can accommodate the high osmolarity of TPN solutions without causing damage or irritation to the vessel. Peripheral veins or less central routes could become occluded or inflamed due to the concentrated solution.
- Long-Term Use: TPN is often administered over extended periods, sometimes for weeks or even months. Central venous access devices, including central lines, peripherally inserted central catheters (PICC lines), and tunneled central catheters, are designed for long-term use and can remain in place without causing significant discomfort or complications.
- Flow Rates: Central venous access provides a large lumen and high flow rates, which are necessary for the effective administration of TPN. It ensures that the solution is diluted quickly by the blood, reducing the risk of complications such as thrombosis or vein irritation.
Other Routes:
- B. Midline Catheter: This is suitable for medium-term intravenous access but is generally used for less concentrated solutions. It does not provide the necessary central access required for TPN.
- C. Subcutaneous: This route is not appropriate for TPN as it is designed for fluids and medications that can be administered in smaller volumes and lower concentrations. TPN is too concentrated for subcutaneous administration.
- D. Intraosseous: This route is typically used for emergency situations when intravenous access is not possible, such as in trauma or severe shock. It is not used for routine TPN administration.
In summary, a central venous access device is the correct choice for administering TPN due to its ability to handle high osmolarity, suitability for long-term use, and capacity to manage high flow rates.