Question

A patient is receiving total parenteral nutrition (TPN). What are the primary interventions the nurse should follow to prevent a central line infection? (Select all that apply.) a. Change the dressing using sterile technique. b. Change TPN containers every 48 hours. c. Change the TPN tubing every 24 hours. d. Monitor glucose levels to watch and assess for glucose intolerance. e. Elevate head of the bed 45 degrees to prevent aspiration.

Short answer

To prevent central line infection while administering TPN: a) Use sterile technique when changing the dressing, c) Change TPN tubing every 24 hours, and d) Monitor glucose levels for glucose intolerance. Elevating the head of the bed is not directly related to preventing central line infection.

Step-by-step solution

Identifying Correct Interventions

Review each intervention listed in the exercise and determine if it is directly related to the prevention of a central line infection in the context of administering TPN.

Selecting Evidence-based Practices

Identify which of the interventions are considered evidence-based practices for the prevention of central line-associated bloodstream infections (CLABSIs).

Understanding Guidelines for TPN

Consider guidelines for TPN administration, such as those provided by infection control protocols and clinical best practices, to make an informed selection.

Cross-referencing Infection Control Measures

Cross-reference the interventions with standard infection control measures such as aseptic technique and frequent monitoring, to ascertain their effectiveness in preventing infections.

Key concepts

Total Parenteral Nutrition (TPN)

Total parenteral nutrition (TPN) is a life-sustaining therapy for patients who cannot receive nutrition through regular food intake or enteral feeding. It involves the administration of nutrients directly into the bloodstream through a central venous catheter. While TPN can be a critical intervention, it poses a risk for central line-associated bloodstream infections (CLABSIs), which can be life-threatening.

Preventing infections in TPN is multifaceted. Nurses must ensure that TPN containers are changed at least every 24 hours—not 48 hours as previously thought—to reduce microbial growth. Similarly, the tubing used for TPN should be replaced daily, as per evidence-based guidelines. Monitoring glucose levels is also pivotal, as hyperglycemia can increase the risk of infection. Furthermore, elevating the head of the bed can help prevent aspiration but is not directly related to central line infection prevention. These steps, along with rigorous infection control practices, are key to safeguarding patients from infection risks associated with TPN.

• Change TPN containers at least every 24 hours to minimize infection risk.
• Replace TPN tubing daily in accordance with evidence-based practices.
• Regular glucose monitoring is critical for detecting and managing hyperglycemia.

Sterile Dressing Technique

The sterile dressing technique is an essential procedure in preventing infections, especially critical when dealing with central venous catheters used in TPN administration. It requires meticulous attention to aseptic principles to avoid contaminating the catheter site. Correct application involves hand hygiene, wearing gloves, and using sterile equipment and supplies.

Nurses should change the dressing at least every 7 days for transparent dressings and every 2 days for gauze dressings, or more frequently if soiled or compromised. Using a sterile dressing kit can minimize the risk of infection through contact and environmental exposure. The procedure includes cleaning the catheter insertion site with appropriate antiseptic, allowing it to dry thoroughly before applying a new dressing. Proper technique in dressing changes is not just a recommendation but a fundamental practice in maintaining catheter integrity and preventing infection.

• Maintain sterile field throughout the dressing change process.
• Clean the insertion site with appropriate antiseptic before dressing application.
• Ensure dressings are changed according to recommended schedules or as needed.

Evidence-Based Nursing Practices

Evidence-based nursing practices are the cornerstone of high-quality clinical care. These practices involve integrating the best available research evidence with clinical expertise and patient values to make decisions about the care of patients. To prevent central line infections in patients receiving TPN, evidence-based guidelines suggest specific interventions.

For example, interventions such as changing TPN tubing every 24 hours and monitoring glucose levels are based on research that indicates these actions can reduce the risk of CLABSIs. Evidence-based practices provide a framework for nurses to deliver safe, effective, and consistent care. They are not static but rather evolve as new research findings emerge. Therefore, nurses must stay informed about the latest evidence to ensure their practice reflects the current state of knowledge.

• Implement interventions supported by high-quality evidence to prevent infections.
• Stay up-to-date with the latest research to constantly improve patient care.
• Combine research findings with clinical judgment and patient preferences for holistic care.