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Total Parenteral Nutrition or TPN Administration and Education

I recently saw a post in a popular nurse’s forum for LVN’s and LPN’s that made me cringe! As an infusion therapy educator I am aware scenarios like this are common and wanted to address some of the issues I see with Total Parenteral Nutrition administration within long term care facilities.

The particular post I saw went something like this: Has anyone ever heard of having total parenteral nutrition (TPN) in long term care or has anyone discharged a patient to a long term care facility with TPN? Personally I think the fifteen minute inservice we got is an accident waiting to happen. No one where I work has a clue about it.  If anyone has any tips for me that would be great. Thanks.

Posts after this did indeed include “tips” for TPN administration as well as another comment that “as an LPN/LVN they were not allowed to touch a TPN.”  I will give kudos to the nurse that posted her tips. The tips for the most part were correct, but not 100% accurate.  It is the typical inaccuracies of the responding posts that lead me to the problem of nurses accepting advice from other nurses in these types of forums, usually the information is not 100% accurate. I will say I agree with the original nurse’s post that a 15minute inservice is highly inadequate and is most certainly “an accident waiting to happen”.

Total Parenteral Nutrition also called TPN or hyperalimentation, involves the intravenous delivery of nutrients consisting of glucose, amino acids, lipids, vitamins and minerals.  This therapy is used when the gastrointestinal tract is not functioning.  The typical conditions that may use TPN as a supplemental treatment would include peritonitis, intestinal blockage, massive intestinal resections or other bowel diseases. TPN is always administered via a central line due to the pH and very high osmolality of the solution.  Remember the definition of a central line is any catheter that the tip resides in the superior vena cava.  PICC's are a type of central line and is very often the type central line used in the long term care setting for TPN administration.

There are some parenteral solutions that are permitted to be given via a peripheral vein, these are often referred to a PPN or peripheral parenteral nutrition.  PPN solutions do not have the concentration of dextrose and amino acids that TPN does and the 2 types of solutions should not be confused.  Any solution with a final dextrose concentration exceeding 10% and an osmolarity of greater than 600 mOsm should be administered via a central venous access device.

TPN administration is complex and the nurse administering PPN or TPN should have knowledge of indications for therapy, side effects, potential adverse reactions and appropriate interventions.  I am quite certain that a 15 minute inservice or a 1 hour inservice is not adequate time to cover these topics adequately.  In addition to specifics of TPN, the nurse should have a knowledge and solid understanding of basic infusion therapy principles and central lines. 

The topic of LVN or LPN administration of TPN is a complex one.  Unfortunately each state handles this scenario differently. To further complicate matters within many states it is left up to facility policy, as to whether or not LPN/LVN’s can administer TPN solutions.  I caution nurses to read their own state scope of practice or nurse practice act and do not depend on what other nurses say, because there is a good deal of confusion on this subject. The advice you receive may be very true for a nurse within their state and facility in which he/she practices, but may not be applicable to your state, facility or situation.

For the states that do allow LPN/LVN’s to administer TPN therapies, most of the board’s indicate the nurse must have documented education on the subject as well as demonstrated competencies. For the states that specifically do not allow a LPN/LVN to hand or administer TPN, they may allow the LVN/LPN to provide care to and monitor the TPN patient. It is also important for these nurse’s to have knowledge of parenteral nutrition, as well as the central venous access devices that are used to administer them.  Without this knowledge how can a nurse adequately and properly assess for complications?

To facilitate your understanding of what is allowed for LPN/LVN’s within your state in regards to TPN administration Pedagogy has provided links to each state board of nursing and where available listed information specific to LPN/LVN IV certification and IV education requirements.  You may find the links to the state board by clicking here.

Pedagogy also offers a 5 contact hour continuing education course Total Parenteral Nutrition in the Adult Patient
This comprehensive course covers:
• Indications for Parenteral Nutrition
• Goals of Parenteral Nutrition
• Normal Nutritional Requirements
• Nutritional Assessment
• Composition of Parenteral Nutrition
• Administration of Parenteral Nutrition
• Complications of Parenteral Nutrition
• Monitoring and Documentation of  Patients on Parenteral Nutrition
 
As with all Pedagogy infusion continuing education courses, this TPN course contains skill competency verification checklists. The skills components if required are completed with a preceptor.  These preceptors are usually a staff development coordinator, DON, ADON or other staff designated within your employers’ organization.  The requirements of skill verifications is determined by your state board of nursing and/or your facility’s policy.

Many RN’s take our online TPN course to refresh their parenteral nutrition knowledge.  We have received many evaluation posts from RN’s that this course provided much more information than they ever received in school!

Pedagogy offers many infusion resource posters that you may print and post, to view a list of our infusion resources including a TPN Monitoring Schedule, click here.

Pedagogy blog written by Capra Dalton, RN,CEO.  

Capra has more than 28 years of experience in infusion therapy and the instruction of licensed nurses in infusion therapy continuing education. Her experience comes from multiple infusion settings: acute care, ambulatory infusion centers, home infusion, long term care continuing education provider, and long term care pharmacy quality assurance consultant. 
Posted: 2/10/2014 2:49:57 PM
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