# INFUSION OF (TPN )TOTAL PARENTERAL NUTRITION AND INTRALIPIDS CALCULATION.NURSES RESPONSIBILITIES.

1.The doctor orders TPN 2000ml(Total parenteral nutrition )to be infused in 24hours. What rate will the Registered nurse infuse it per hour?.

solve : 2000÷ 24 = 83.3 .

( It is ordered in hours,so you don’t need to convert to minutes. Simply divide amount by hours)

2.The doctor orders TPN 1656ml for Mr Johnson who has difficulty to swallow and cannot tolerate ngt feeding to infuse over 24hours. What will be the hourly rate?.

Solve : 1656÷24 =69ml/hour.

3.Doctor Seeme orders TPN 1500ml for your 75years old female to infuse in 18hours.At what rate will you infuse?.

Solve:Total amount ÷ by total hours.

Total amount =1500ml.

Total hours = 18hours.

4.The doctor orders 180ml of intralipids to be infused over 18hours. At what rate will the Registered Nurse infuse ?.

Solve: 180ml ÷18=10ml/hour.

NB: Most hospitals don’t allow LVN/LPN to infuse TPN or LIPID because it is above their scope of practice.

5. Doctor Seeme orders Intralipids for 80ml to infuse in 18hours. At what rate will the Registered Nurse infuse the intralipids?

Solve: 80ml/18ml = 4.4 you round it up to 4ml/hour.

NB: Please note that TPN bag must be discarded after 24hours that is the “Gold Standard”. Even if you have 500ml left in the bag.After 24hours a new bag is prepare by pharmacy according to doctor orders.

Nursing Responsibilities.

1. Hang the TPN as ordered with the correct tubing. If you are not sure ask questions. ( Asking questions does not take away your intelligence or beauty. You are still cute.So ask question when in doubt. )
2. Check the laboratory results.
3. Check blood sugar every 6hours and notify the doctor for any changes.
4. Call and remind the pharmacy to prepare the TPN.Some pharmacist might be too busy to remember. They have crazy days too.
5. Educate your patients and encourage them to ask questions and verbalize their concerns.
6. Monitor intake and output.
7. Timing: Hang the TPN on time.In most facilities, it is hang at 1800.
8. You need a central line or picc line for TPN because of the viscosity of TPN. You can use 16guage,18guage or 20guage for Peripheral Parenteral nutrition. (PPN).Please follow your facility policy and procedures.

Change the central line or picc line dressing per facility policy and procedures.