Administering Peripheral Partial Nutrition

• To provide a nutrition source for patients who are unable to process nutrients normally, such as patients requiring bypass of the gastrointestinal tract.
• Provides increased calories for patients in a catabolic state.
• These solutions/medications will often include: potassium or magnesium supplements and amino acids.
• To prevent or correct a deficiency of essential electrolytes.

• Determine patient's ability to understand the purpose of peripheral partial nutrition therapy.
• Assess patient's current diet (nothing by mouth [NPO] or diet type, percutaneous endoscopic gastrostomy [PEG], or feeding tube).
• Assess nutrition needs of patient related to electrolyte imbalance or amino acid deficiency.
• Check prescriber's orders for correct additives for each bottle or bag.
• Check rate of infusion according to physician's orders, and monitor closely.
• Monitor patient's electrolyte, blood glucose, and amino acid blood values.
• Keep family informed of therapy procedure, possible complications, and patient's tolerance of IV solution.

Special Considerations

Elderly and Pediatric Patients

• Monitor closely for signs of circulatory overload and hyperglycemia. Notify prescriber as needed.

Relevant Nursing Diagnoses

• Altered nutrition: less than body requirements related to nausea, vomiting, anorexia, and/or surgery
• Risk for decreased cardiac output related to circulatory overload
• Risk for electrolyte imbalance related to intolerance of IV solution mixture

• Peripheral partial nutrition therapy is infused at prescribed flow rate and tolerated by patient
• IV site remains dry, intact, and free of infection and inflammation
• Patient's electrolytes are maintained within normal parameters

• Solution and/or medication to be administered IV (may be refrigerated or not, depending upon the solution/medication)
• Clean gloves (optional)
• IV tubing, filter (if indicated), and infusion pump
• Extension tubing
• I & O record

• Identify patient; explain purpose, and procedure.
• Prevents administration error. Meets patient's right to be informed and encourages cooperation.
• Gather equipment and place at bedside.
• Enhances organization and provides optimal lighting environment.
• Wash hands, and don clean gloves.
• Reduces transmission of infectious microorganisms.
• Position in bed in supine position or sitting up in a chair at the bedside, depending on patient's activity status.
• Patient comfort.
• Obtain the prescribed IV solution/medication. Allow bag to warm to room temperature by removing it from the refrigerator approximately 30 minutes before use.
• Solution is refrigerated to prevent growth of organisms, but should be left at room temperature for 30 minutes to 1 hour prior to use.
• Connect IV tubing and solution container. Check facility policy and procedure manual for frequency of changing tubing.
• Ensures that tubing and container are properly connected; ensures adherence to policy and procedure of changing tubing.
• Prime IV tubing to clear air.
• Prevents air entering patient's blood stream and causing an air embolism.
• Place IV tubing through infusion pump and connect to primary IV line.
• Controls rate of infusion and prevents fluid overload from too-rapid administration.
• Remove gloves and discard, then wash hands.
• Ensures solution has begun without complications; prevents transmission of infectious microorganisms.

Evaluation and Follow-Up Activities

• Evaluate patient compliance and tolerance
• Monitor appropriate blood studies—that is, electrolytes and amino acids
• Monitor and maintain an accurate intake and record
• Assess IV for complications (air embolus, infiltration)

Key Points for Reporting and Recording

• Record date and time that solution is hung and flow rate.
• Results of appropriate blood studies—that is, electrolytes.
• Condition of IV site; status of dressing, and if changed.
• Patient's tolerance of procedure and any problems that occurred.
• Patient's most recent body weight.
• I & O.