Fluid overload

It is important that strict asepsis (gloves and masks) be used when changing the IV tubing and the dressing at the infusion site because parenteral nutrition solutions are an excellent medium for yeast and bacteria to grow. The pharmacy uses a laminar airflow hood when preparing parenteral nutritional solutions to reduce this risk.

Monitor the patient carefully for hyperglycemia when you initiate parenteral nutrition support because the pancreas needs time to adjust to the hypertonic dextrose solution, which is high in glucose. Sometimes hyperglycemia is temporary and dissipates once the pancreas makes the necessary adjustments.

However, hyperglycemia might persist if the infusion rate is too fast. To prevent this from occurring, begin with 1 liter of solution for the first 24 hours. Increase this by 500 to 1000 mL each day until you reach a daily volume of 2500 mL to 3000 mL.

Change the solution and tubing every 24 hours. Change the dressing every 48 to 72 hours or according to the agency policy.

Caution: Don't suddenly interrupt parenteral nutrition support because the patient can experience hypoglycemia. Discontinue gradually by decreasing the infusion rate. However, hypoglycemia may occur in spite these precautions.

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