Fundamentals of Nursing Q 330
A client is receiving parenteral nutrition (PN) and is suddenly having a fever. A nurse notifies the physician and the physician initially prescribes that the solution and tubing be changed. The nurse should do which of the following with the discontinued materials?
A. Send them to the laboratory for culture.
B. Save them for a return to the manufacturer.
C. Return them to the hospital pharmacy.
D. Discard them in the unit trash.
Correct Answer: A. Send them to the laboratory for culture.
When the client who is receiving PN has a high temperature, a catheter-related infection should be suspected. The solution and tubing should be changed, and the discontinued materials should be cultured for an infectious organism. Septic complications of central venous catheters (CVCs) remain a significant cause of patient morbidity and mortality both in the intensive care unit (ICU) and in general hospital wards. Approximately 25% of CVCs inserted have been reported to become colonized, with rates of catheter-related bloodstream infection (CRBSI) varying between 0% and 11%.
Option B: The solution and tubing should be brought immediately to the laboratory to avoid the growth of other organisms. It has been proposed that TPN, being a potential culture medium, is an independent risk factor for CRBSI. However, there is a paucity of studies related to CVC colonization and CRBSI and in patients receiving TPN via short-term CVCs.
Option C: Returning the solution to the pharmacy is not the appropriate action. Patients receiving total parenteral nutrition (TPN) are at high risk for bloodstream infections (BSI). The notion that intravenous calories and glucose lead to hyperglycemia, which in turn contributes to BSI risk, is widely held.
Option D: Do not discard the solution and tubing immediately. Other studies have shown an increased infection risk without a survival benefit in patients receiving TPN. There is a reported sepsis incidence of between 20% and 30% in patients receiving parenteral nutrition. The high risk of sepsis is a major factor leading to an overall preference for enteral nutrition over parenteral nutrition.