Central Parenteral Nutrition Essay

Central Parenteral Nutrition Essay

Central Parenteral Nutrition Essay

Central Parenteral Nutrition

The promotion of adequate nutrition in critically ill patients is important in nursing care. Central parenteral nutrition is an approach that is applicable to enhancing the nutritional status of critically ill patients. Central parenteral nutrition entails the delivery of nutrients directly to the right atrium or superior vena cava using a central venous access (Hamdan& Puckett, 2021). An example of a patient requiring central parenteral nutrition is a patient presenting with bowel obstruction. The patient presents with abdominal distention, abdominal pain, vomiting, and lack of dietary intake for the last three days. The management entails the initiation of central parenteral nutrition for stabilization prior to emergency surgical procedures. Therefore, the purpose of this research paper is to explore central parenteral nutrition, including its uses, benefits and risks, interdisciplinary team members, nursing scope, and patient education.

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Explanation and Background

Central parenteral nutrition is the selected therapeutic modality. Central parenteral nutrition is an approach to delivering highly nutritious diets to patients that cannot feed orally and critically ill. The modality delivers nutrients directly to the right atrium or superior vena cava through a centrally inserted catheter. Central parenteral nutrition delivers nutrition comprising of dextrose, emulsions, vitamins, amino acids, trace elements, minerals, and electrolytes to the patient’s system (Hamdan & Puckett, 2021). The central catheter also plays other roles such as the administration of medications, including chemotherapy for patients with cancer. Central parenteral nutrition is used in a wide range of patients. They include those suffering from bowel obstruction, short bowel syndrome, gastrointestinal fistula, prolonged bowel rest, severe malnutrition, and cancers such as those of the esophagus and stomach. It is also indicated in conditions such as immaturity of the gastrointestinal system secondary to congenital malformations, severe vomiting or diarrhea, hypercatabolic states due to polytrauma or sepsis and in patients who should be on nothing by mouth for a period of more than seven days (Lappas et al., 2018). Central parenteral nutrition is relatively safe when used according to the recommended guidelines. The insertion process should be done aseptically to minimize the risk of infections and other complications. The medications used in the insertion of the central venous catheter include a local anesthetic agent to prevent pain (Wyer, 2017). The cost of central parenteral nutrition depends on factors such as the duration of the use of the central catheter and its intended purposes such as nutrition or chemotherapy purposes.

Risks and Benefits

Central parenteral nutrition benefits the patients by ensuring that the promotion of their adequate body nutrition. Through the central parenteral nutrition, patients are assured of optimum nutritional status irrespective of their health status to prevent malnutrition and promote the healing process. Central parenteral nutrition also ensures electrolyte balance. The modality acts as a way of delivering the required electrolytes to correct any imbalances that could result in adverse patient outcomes (Micic et al., 2019). Central parenteral nutrition also prevents muscle wasting or loss by ensuring the maintenance of the optimum nutritional needs of the body. The promotion of positive outcomes is important in central parenteral nutrition. Dibb and Lal (2017) assert that the outcomes are achievable using interventions such as ensuring aseptic techniques in catheter insertion, monitoring for signs of infection, educating patients about the procedure and care of the catheter, adequate nutritional calculation, interdisciplinary collaboration, and prophylactic administration of antibiotics and medications to prevent thrombosis.

Central parenteral nutrition however has several complications. They include pneumothorax, hemorrhage, and air embolism, and venous thrombosis, injury to the vasculature, sepsis, and local skin infection. It also predisposes patients to re-feeding syndrome, hyperglycemia, hypoglycemia when suddenly discontinued, electrolyte imbalances, Wernicke’s encephalopathy, cholestasis, and deficiency of micronutrients (Hamdan& Puckett, 2021; Santacruz et al., 2019; Wyer, 2017). Several considerations for preventing complications exist. They include using implanted and tunneled catheters in case of long-term use, antimicrobial-coated central catheters, single-lumen catheters, maximal barrier precautions during the process of catheter insertion, and 2% chlorhexidine antiseptic on the skin (Martincich et al., 2020). The other interventions include the regular changing of the administration sets, using venipuncture guided by an ultrasound, close monitoring of vitals and blood gas analysis, and provider and patient education on care of central catheter.

Interdisciplinary Team’s Roles and Responsibilities

The caring of patients on central parenteral nutrition is multidisciplinary. The multidisciplinary team comprises of healthcare providers such as nurses, physicians, nutritionists, and physiotherapist. Physicians play the roles of prescribing patients parenteral nutrition and insertion of the central venous catheter (Gallotto et al., 2019). They also monitor the patients for any signs of complications associated with the modality. Registered nurses monitor the patients for any complications. They also administer parenteral nutrition to the patients. They also educate the patients about the benefits, risks and ways of minimizing complications with central parenteral nutrition (Gallotto et al., 2019). Nutritionists determine the nutritional status of the patients and recommend the need for changes in the amount and frequency of diets. Physiotherapists assist patients in engaging in a wide range of motion exercises to prevent thrombosis and maintain normal muscle function. As noted, the nurse performs functions such as patient education, assessment, coordinating care, communicating any concerns to the physicians, and evaluating the effectiveness of the therapy. They also administer medications and nutrition, communicate any potential or actual complications and act as the advocates of the patients. One of the challenges that may be experienced in working in an interdisciplinary team is complexity in decision-making. The decision-making incorporates inputs from different healthcare stakeholders, which may take time.

Nursing Scope of Practice

The registered nurse should be knowledgeable in caring a patient on central parenteral nutrition. First, the nurse should have knowledge on the indications and contraindications of central parenteral nutrition. They should also have knowledge in determining the nutritional requirements of their patients and nutritional administration (Gallotto et al., 2019). They should also be knowledgeable on the identification and prevention of complications of the modality. The registered nurses should also be skilled in caring patients on central parenteral nutrition. Accordingly, they should be skillful in educating and demonstrating to the patients the use and care of the central parenteral nutrition and catheter. They should also have skills on the administration of the central parenteral nutrition, monitoring and management of complications (Gallotto et al., 2019). The attitude of the nurse should be characterized by honesty, openness, and being willing to explore innovative interventions for their patients.

Patient Education

Patient education is important for the realization of optimum outcomes with central parenteral nutrition. The registered nurse should educate the patients and their families about the indications and need for central parenteral nutrition. The patient and family should also be educated about the care of the catheter. They should also be informed about the strategies of minimizing infections on the catheter insertion site (Gallotto et al., 2019). The patient and the family also need education about signs and symptoms of complications they should report. Patient education will be undertaken using question-answer approach. Demonstrations will also be used to ensure the patient and family learns the best practice skills for catheter care (Gallotto et al., 2019). The cultural considerations that should be incorporated into the plan include those related to nutrition and nutritional supplements. The patient and the family should be informed about the adequate nutrition of the parenteral diets. The teaching can be evaluated by asking the patient and the family questions that relate to the key areas of knowledge and skills in central parenteral nutrition.

Conclusion

Central parenteral nutrition is a modality used in patients that cannot tolerate ingested foods. The modality ensures optimum nutritional status and electrolyte balance in patients at risk. The modality is associated with several complications that the nurse must be able to identity and manage effectively. Patient education should be incorporated into the treatment plan to enhance positive outcomes.

References

Dibb, M., &Lal, S. (2017).Home Parenteral Nutrition: Vascular Access and Related Complications.Nutrition in Clinical Practice, 32(6), 769–776. https://doi.org/10.1177/0884533617734788

Gallotto, M., Rosa, C. M., Takvorian-Bené, M., McClelland, J., Tascione, C., Carey, A., & Raphael, B. P. (2019).Caregiver Training for Pediatric Home Parenteral Nutrition: A 5-Session Discharge Curriculum.Journal of Infusion Nursing, 42(3), 132–136. https://doi.org/10.1097/NAN.0000000000000320

Hamdan, M., & Puckett, Y. (2021).Total Parenteral Nutrition.In StatPearls.StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK559036/

Lappas, B. M., Patel, D., Kumpf, V., Adams, D. W., &Seidner, D. L. (2018). Parenteral Nutrition: Indications, Access, and Complications.Gastroenterology Clinics, 47(1), 39–59. https://doi.org/10.1016/j.gtc.2017.10.001

Martincich, I., Cini, K., Lapkin, S., Lord, H., & Fernandez, R. (2020). Central Venous Access Device Complications in Patients Receiving Parenteral Nutrition in General Ward Settings: A Retrospective Analysis.Journal of Parenteral and Enteral Nutrition, 44(6), 1104–1111. https://doi.org/10.1002/jpen.1743

Micic, D., Semrad, C., & Chopra, V. (2019).Choosing the Right Central Venous Catheter for Parenteral Nutrition.Official Journal of the American College of Gastroenterology | ACG, 114(1), 4–6. https://doi.org/10.1038/s41395-018-0203-8

Santacruz, E., Mateo-Lobo, R., Riveiro, J., Nattero, L., Vega-Piñero, B., Lomba, G., Sabido, R., Carabaña, F., Arrieta, F. J., &Botella-Carretero, J. I. (2019).Infectious complications in home parenteral nutrition: A long-term study with peripherally inserted central catheters, tunneled catheters, and ports.Nutrition, 58, 89–93. https://doi.org/10.1016/j.nut.2018.06.016

Wyer, N. (2017).Parenteral nutrition: Indications and safe management.British Journal of Community Nursing, 22(Sup7), S22–S28. https://doi.org/10.12968/bjcn.2017.22.Sup7.S22

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Follow these guidelines when completing this assignment.
1) Adult patient only-Phoenix Addendum
2) Choose a therapeutic modality or healthcare technology.
3) Examples of a therapeutic modality include Extracorporeal Membrane Oxygenation, Automatic rotating pronation beds, right and/or left ventricular assist devices, nontraditional ventilator modes.
4) Examples of healthcare technology can include regional O2 saturation monitoring (NIRS).
5) Refer to your faculty member if your selection requires prior approval.
6) Write a 4-5-page paper (not including the title page or reference page) using APA format.
a. Phoenix Addendum: Expository essay format (page 10 of the 7th ed APA)
7) For APA, formatting, or grammar assistance visit the APA Citation and Writing page in the online library.
8) Include the following sections (detailed criteria listed below and in the Grading Rubric):
a. Introduction – 5 points/5%
• The chosen therapeutic modality or healthcare technology meets one of the following criteria:
o Has been introduced recently at the bedside for care of the complex adult patient.
o Is a non-traditional modality for very ill patients in special circumstances.
o Is being used in a new way to treat a patient with complex needs.
o Requires specific training above and beyond general entry-level nursing education.
• Introduce the therapeutic modality or healthcare technology.
• Name the therapeutic modality or healthcare technology.
• A brief fictional case on a complex adult patient is used to illustrate the therapeutic modality or healthcare technology.
b. Explanation and Background– 15 points/15%
• Include a clear description of the therapeutic modality or healthcare technology.
• Discuss how the therapeutic modality or healthcare technology works.
• Describe the patient population it is used for.
• Include medication, safety, and cost considerations as applicable.
c. Risks and Benefits– 15 points/15%
• Describe how the therapeutic modality or healthcare technology can benefit the patient.
• Discuss ways to promote positive outcomes.
• Explain the complications that may arise.
• Discuss considerations for preventing complications.
d. Interdisciplinary team’s Roles and Responsibilities– 20 points/20%
• Identify all interdisciplinary team members caring for the patient, such as respiratory therapy, assistive personnel, providers, case managers, clinical nurse specialists, and researchers.
• Describe the roles and responsibilities of each member of the healthcare team that is involved in the use of the therapeutic modality or healthcare technology.
• Discuss the roles and responsibilities of the nurse as a member of the interdisciplinary team caring for the patient.
e. Nursing Scope of Practice – 15 points/15%
• Discuss the knowledge needed for the Registered Nurse to provide care for the patient using the therapeutic modality or healthcare technology.
• Describe skills needed for the Registered Nurse to provide care for the patient using therapeutic modality or healthcare technology.
• Discuss attitudes needed for the Registered Nurse to provide care for the patient using therapeutic modality or healthcare technology.
f. Patient Education – 20 points/20%
• Describe the information to be taught to the patient and/or family.
• Discuss how information will be taught.
• Explain how the effectiveness of the teaching will be evaluated.
g. Conclusion – 5 points/5%
• Provide a summary of the paper.
• No new information is introduced.
• Include additional resources for further learning.
h. APA Style and Organization – 5 points/5%
• References are submitted with paper.
• Uses current APA format and is free of errors.
• Grammar and mechanics are free of errors.
• At least three (3), nursing, scholarly, peer reviewed, primary sources from the last 5 years, excluding the textbook, are provided