Definition

Sterile solutions containing some or all of the nutrients necessary to support life, are injected into the body through a tube attached to a needle, which is inserted into a vein, either temporarily or for long-term treatment.

  Purpose

Patients who cannot consume enough nutrients or who cannot eat at all due to an illness, surgery, or accident, can be fed through an intravenous (IV) line or tube. An IV can be used for as little as a few hours, to provide fluids to a patient during a short surgical procedure, or to rehydrate a patient after a viral illness.

Patients with more serious and long term illnesses and conditions may require months or even years of intravenous therapy to meet their nutritional needs. These patients may require a central venous access port. A specialized catheter (Silastic Broviac or Hickman) is inserted beneath the skin and positioned below the collarbone. Fluids can then be injected directly into the bloodstream for long periods of time. X rays are taken to ensure that the move permanent catheter is properly positioned.

  Precautions

Patients receiving IV therapy need to be monitored to ensure that the IV solutions are providing the correct amounts of fluids, minerals, and other nutrients needed.

  Description

There are two types of IV, or parenteral, nutrition. Parenteral nutrition is that which is delivered through a system other than the digestive system. In this case, the nutrition is delivered through a vein. Partial parenteral nutrition (PPN) is given for short periods of time, to replace some of the nutrients required daily and only supplements a normal diet. Total parenteral nutrition (TPN) is given to someone who cannot eat anything and must receive all nutrients required daily through an intravenous line. Both of these types of nutrition can be performed in a medical facility or at the patient's home. Home parenteral nutrition (HPN) usually required a central venous catheter, which must first be inserted in a fully equiped medical facility. After it is inserted, therapy can continue at home.

Basic IV solutions are sterile water with small amounts of sodium (salt) or dextrose (sugar) supplied in bottles or thick plastic bags that can hang on a stand mounted next to the patient's bed. Additional minerals, like potassium and calcium, vitamins, or drugs can be added to the IV solution by injecting them into the bottle or bag with a needle. These simple sugar and salt solutions can provide fluids, calories, and electrolytes necessary for short periods of time. If a patient requires intravenous feeding for more than a few days, additional nutrients like proteins and fats will be included. The amounts of each of the nutrients to be added will depend on the patient's age, medical condition, and particular nutritional requirements.

  Preparation

A doctor orders the IV solution and any additional nutrients or drugs to be added to it. The doctor also specifies the rate at which the IV will be infused. The IV solutions are prepared under the supervision of a doctor, pharmacist, or nurse, using sanitary techniques that prevent bacterial contamination. Just like a prescription, the IV is clearly labeled to show its contents and the amounts of any additives. The skin around the area where the needle is inserted is cleaned and sanitized. Once the needle is in place, it will be taped to the skin to prevent it from dislodging.

In the case of HPN, the IV solution is delivered to the patient's home on a regular basis and should be kept refrigerated. Each bag will have an expiration date, by which time the bag should be used. The solution should be allowed to be warmed to room temperature before intravenous nutrition begins.

  Aftercare

Patients who have been on IV therapy for more than a few days may need to have foods reintroduced gradually to give the digestive tract time to start working again. After the IV needle is removed, the site should be inspected for any signs of bleeding or infection.

When using HPN, the catheter should be kept clean at all times. The dressings around the site should be changed at least once a week and the catheter site should be monitored closely for signs of redness, swelling, and drainage. The patient's extremities should be watched for swelling, which is a sign of nutritional imbalance.

  Risks

There is a risk of infection at the injection site, and for patients on long term IV therapy, the risk of an infection spreading to the entire body is fairly high. It is possible that the IV solution may not provide all of the nutrients needed, leading to a deficiency or an imbalance. If the needle becomes dislodged, it is possible that the solution may flow into tissues around the injection site rather than into the vein. The patient should be monitored regularly, particulary if receiving HPN, as intravenous nutrition can potentially cause infection at the site of the catheter, high blood sugar, and low blood potassium, which can all be life-threatening.

   Key Terms:

Home parenteral nutrition (HPN) Long-term parenteral nutrition, given through a central venous catheter and administered in the patient's home. Intravenous Into a vein; a needle is inserted into a vein in the back of the hand, inside the elbow, or some other location on the body. Fluids, nutrients, and drugs can be injected. Parenteral Not in or through the digestive system. Parenteral nutrition is given through the veins of the circulatory system, rather than through the digestive system. Partial parenteral nutrition (PPN) A solution, containing some essentail nutrients, is injected into a vein to supplement other means of nutrition, usually a partially normal diet of food. Total parenteral nutrition (TPN) A solution containing all the required nutrients including protein, fat, calories, vitamins, and minerals, is injected over the course of several hours, into a vein. TPN provides a complete and balanced source of nutrients for patients who cannot consume a normal diet.

   Resources:

Books

• Howard, Lyn. "Enteral and Parenteral Nutrition Therapy." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
• "Parenteral Nutrition." In The Encyclopedia of Nutrition and Good Health. New York: Facts On File, Inc., 1997.
• "Parenteral Nutrition." In The Merck Manual. 16th ed. Ed. Robert Berkow. Rahway, NJ: Merck Research Laboratories, Merck & Co., Inc., 1992.

Other

• "Clinical Management: Parenteral Nutrition" In Revised Intravenous Nursing Standards of Practice. http://www.ins1.org.