A nurse is preparing a 2-in-1 TPN with a separate lipid infusion. Where should the 1.2-micron filter be placed?
Immediately below the TPN bag
At the IV pump
Below the Y-site where the lipid and TPN infusions meet
Anywhere in the tubing because location is not important
A clinician wants to start TPN in a patient expected to require nutrition support for several weeks. Which access device is most appropriate for short-to-intermediate term therapy?
Peripheral IV catheter
PICC line
Midline catheter
Arterial line
A pharmacist is preparing a TPN formulation containing amino acids and dextrose. The calculated osmolarity is 1,200 mOsmol/L. What is the safest route of administration?
Central venous access because the osmolarity exceeds 900 mOsmol/L
Either peripheral or central access because lipids are not included
Peripheral IV because the osmolarity is below 1,500 mOsmol/
Peripheral IV because the solution contains amino acids
A patient has a triple-lumen central venous catheter. Which setup represent best use of the line?
Run intermittent antibiotics through the TPN tubing
Y-site all medications into the TPN lumen
Use one lumen exclusively for TPN
Alternate TPN and medications through the same lumen
A provider requests that an IV antibiotic be piggybacked into the TPN line because all peripheral access has failed. What is the strongest reason to avoid this practice?
TPN causes immediate antibiotic inactivation.
Mixing medications with TPN can alter pH and promote precipitation
Antibiotics always require a peripheral line.
The filter prevents antibiotic delivery
A TPN infusion running at 80 mL/hr must be stopped unexpectedly because the bag was found leaking. Pharmacy will need 45 minutes to prepare a replacement. What is the best immediate intervention?
Stop all IV fluids until the new bag arrives.
Infuse normal saline at 80 mL/hr.
Reduce the rate to 40 mL/hr and wait.
Infuse 10% dextrose at 80 mL/hr.
Why can abrupt discontinuation of TPN cause hypoglycemia in some patients?
The liver suddenly releases excess insulin.
Glucose infusion stops immediately while insulin levels remain elevated briefly.
Peripheral tissues become resistant to insulin.
Lipid metabolism accelerates and consumes glucose
A nutrition support pharmacist is deciding between peripheral and central administration for a new TPN formulation. Which characteristic is the primary determinant?
Patient age
Infusion pump type
Osmolarity of the TPN solution
Lipid brand
A provider argues that a peripheral IV should be adequate for TPN because the catheter was inserted using sterile technique. Which response best addresses the primary safety issue?
Sterility eliminates the risk of phlebitis.
The main concern is the high osmolarity of TPN, which can damage peripheral veins.
Peripheral veins cannot receive dextrose-containing solutions.
Central lines are required only when lipids are included.
A newly hired pharmacist suggests that a patient could safely receive hyperosmolar TPN through a peripheral IV if the infusion rate were reduced by half.
Slowing the infusion eliminates precipitation but not infection.
Peripheral administration is determined primarily by osmolarity rather than infusion rate.
Lower infusion rates increase the risk of hypoglycemia.
TPN containing amino acids should never be infused continuously.