SCIENCE PHOTO LIBRARY
CPD practice profile
Parenteral nutrition A CPD article improved Suzie Robertson’s knowledge and understanding of parenteral feeding and nutritional solutions Parenteral nutrition is a method of administering nutrition and hydration intravenously. Usually, nutrients are absorbed from the different foods we consume via the action of enzymes in the gastrointestinal tract. In parenteral nutrition, these nutrients are delivered directly into the bloodstream via a venous access device, bypassing the gastrointestinal tract. Parenteral nutrition may be the only option to ensure adequate nutrition is administered to a patient when complications arise within the gastrointestinal tract. There are two types of venous access for parenteral nutrition: peripheral and central. When deciding which to use, the patient’s nutrition and fluid requirements, period of time for which parenteral nutrition is required, patient’s overall clinical condition, availability of local expertise to insert catheters, and local policies and protocols should be considered. Peripheral venous access involves placement of a catheter
NURSING STANDARD
into a peripheral vein to administer medication and nutrition. It is recommended that peripheral access should be used for solutions of low osmolarity only, and these would be low in calories. In practice, it is important to be aware that patients are at risk of thrombophlebitis, so the access site should be monitored for signs of pain, erythema and swelling. Central venous access is used for patients who require parenteral nutrition for a longer period of time. Central venous access allows the parenteral solution to flow directly into the central veins of the body, enabling solutions of
This practice profile is based on NS702 Fletcher J (2013) Parenteral nutrition: indications, risks and nursing care. Nursing Standard. 27, 46, 50-57.
higher osmolarity and calories to be administered. In addition, it has a lower risk of thrombophlebitis. However, central access increases the risk of catheter-related bloodstream infections and pneumothorax, haemothorax, air embolism, arterial puncture, nerve injury and haematomas can result during catheter insertion. Formulation-related risks include hyperglycaemia because of high glucose content, liver dysfunction and fluid and electrolyte imbalances. Therefore, it is important to monitor patients receiving parenteral nutrition, including blood pressure, pulse, temperature, oxygen saturation and respiratory rate. These clinical observations would help to alert clinicians if sepsis, dehydration or fluid overload was present. It is important to monitor the patient’s blood glucose levels because hyperglycaemia is related to the formulation of parenteral nutrition and could indicate complications. The patient’s fluid intake and output, and weight should be measured, with regular biochemical monitoring to detect abnormal liver function and re-feeding syndrome. After reading the CPD article and writing this practice profile, I am more confident in my understanding of parenteral nutrition and I intend to expand my knowledge by reading about the formulation of nutritional solutions NS Suzie Robertson is a nurse at Northern General Hospital in Sheffield
Write your own practice profile You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a practice profile. Turn to page 49 for this week’s article and on page 62 you can find out how to present and submit your practice profile.
Visit the RCN Learning Zone The RCN Learning Zone is a FREE online service to help RCN members with their continuing professional development and professional portfolio management. The RCN Learning Zone can be found at www.rcn.org.uk/members/learningzone.php march 26 :: vol 28 no 30 :: 2014 61
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 23, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
CPD practice profile
Parenteral nutrition A CPD article improved Suzie Robertson’s knowledge and understanding of parenteral feeding and nutritional solutions Parenteral nutrition is a method of administering nutrition and hydration intravenously. Usually, nutrients are absorbed from the different foods we consume via the action of enzymes in the gastrointestinal tract. In parenteral nutrition, these nutrients are delivered directly into the bloodstream via a venous access device, bypassing the gastrointestinal tract. Parenteral nutrition may be the only option to ensure adequate nutrition is administered to a patient when complications arise within the gastrointestinal tract. There are two types of venous access for parenteral nutrition: peripheral and central. When deciding which to use, the patient’s nutrition and fluid requirements, period of time for which parenteral nutrition is required, patient’s overall clinical condition, availability of local expertise to insert catheters, and local policies and protocols should be considered. Peripheral venous access involves placement of a catheter
NURSING STANDARD
into a peripheral vein to administer medication and nutrition. It is recommended that peripheral access should be used for solutions of low osmolarity only, and these would be low in calories. In practice, it is important to be aware that patients are at risk of thrombophlebitis, so the access site should be monitored for signs of pain, erythema and swelling. Central venous access is used for patients who require parenteral nutrition for a longer period of time. Central venous access allows the parenteral solution to flow directly into the central veins of the body, enabling solutions of
This practice profile is based on NS702 Fletcher J (2013) Parenteral nutrition: indications, risks and nursing care. Nursing Standard. 27, 46, 50-57.
higher osmolarity and calories to be administered. In addition, it has a lower risk of thrombophlebitis. However, central access increases the risk of catheter-related bloodstream infections and pneumothorax, haemothorax, air embolism, arterial puncture, nerve injury and haematomas can result during catheter insertion. Formulation-related risks include hyperglycaemia because of high glucose content, liver dysfunction and fluid and electrolyte imbalances. Therefore, it is important to monitor patients receiving parenteral nutrition, including blood pressure, pulse, temperature, oxygen saturation and respiratory rate. These clinical observations would help to alert clinicians if sepsis, dehydration or fluid overload was present. It is important to monitor the patient’s blood glucose levels because hyperglycaemia is related to the formulation of parenteral nutrition and could indicate complications. The patient’s fluid intake and output, and weight should be measured, with regular biochemical monitoring to detect abnormal liver function and re-feeding syndrome. After reading the CPD article and writing this practice profile, I am more confident in my understanding of parenteral nutrition and I intend to expand my knowledge by reading about the formulation of nutritional solutions NS Suzie Robertson is a nurse at Northern General Hospital in Sheffield
Write your own practice profile You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a practice profile. Turn to page 49 for this week’s article and on page 62 you can find out how to present and submit your practice profile.
Visit the RCN Learning Zone The RCN Learning Zone is a FREE online service to help RCN members with their continuing professional development and professional portfolio management. The RCN Learning Zone can be found at www.rcn.org.uk/members/learningzone.php march 26 :: vol 28 no 30 :: 2014 61
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 23, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
