The nurse is caring for a client with surgical complications who requires continuous total parenteral nutrition (TPN). The nurse assists the health care provider with the insertion of a subclavian triple lumen central venous access device. What is the nurse's priority action before initiating the TPN infusion?

Question

Quizplus · Accepted Answer

The priority action after placing a subclavian central venous catheter is to check the results of the chest x-ray to ensure that the catheter tip is placed correctly in the superior vena cava. Obtain verification before using the catheter as perforation of the visceral pleura can occur during insertion and lead to an iatrogenic pneumothorax or hemothorax. Although these complications are rare, due to the use of ultrasound to guide insertion, if present, the TPN would infuse into the pleural space. (Option A) Filters are used during TPN infusion to remove particulate matter, precipitates, or microorganisms. Because TPN uses a hypertonic solution (eg, dextrose concentration >10%), it increases the risk for infection. Therefore, the use of a 0.22-micron filter is recommended to remove microorganisms when administering a lipid-free formula. The use of a 1.2-micron filter is recommended when administering TPN with lipids. Although this action is appropriate, it is not the priority. (Option B) The nurse should monitor the baseline blood glucose (BG) level and fingerstick BG every 6 hours while the client is receiving TPN; it should be maintained in the range of 140-180 mg/dL (7.8-10.0 mmol/L) for a hospitalized adult client. This action is appropriate, but it is not the priority. (Option D) TPN is always administered using an electronic infusion pump to ensure an accurate and consistent hourly infusion rate to help avoid fluctuations in BG levels. This action is appropriate, but it is not the priority. Educational objective: Incorrect placement of a subclavian central venous catheter can result in an iatrogenic pneumothorax or hemothorax. The priority is to check the results of the chest x-ray to verify that the catheter tip has been placed correctly in the superior vena cava. Other appropriate actions include attaching a filter to the IV tubing, monitoring baseline and fingerstick BG levels every 6 hours, and programming the electronic infusion device to ensure an accurate and consistent hourly infusion rate.

The Nurse Is Caring for a Client with Surgical Complications