Steps

Rationale/Points of Emphasis

1 Gather the necessary supplies. Perform hand hygiene.

Promotes efficient time management and provides an organized approach to the procedure. Reduces transmission of microorganisms.

2 Place the solution bag on clean work surface. Solution should be at room temperature.

Infusing a cold solution may cause hypothermia.

Never warm the solution in a microwave; use warm water bath if necessary. Microwaving may cause the solution to heat unevenly and deterioration of components within the solution.

3a Inspect solution. Verify label against the healthcare prescriber’s orders. Examine solution and container for clarity, signs of contamination, or particles. Do not infuse if the solution has expired, is cloudy, has crystals, or has leaks.

Reduces chance of child receiving incorrect or contaminated solution.

3b Identify the child utilizing two different patient identifiers. Match identification with label on the solution bag.

Reduces incidence of solution being administered to the wrong child.

4 Examine the infusion device and site for type, placement, patency, and signs of infection. Immediately report any signs or symptoms of infection to the healthcare prescriber

Decreases chance of complications.

5 Set up tubing and pump:

Prepares line for infusion.

5a If tubing does not have micron filter, add 0.2-micron filter to the tubing.

5b Spike the solution bag.

5c Prime the tubing according to the manufacturer’s directions.

5d Attach to electronic infusion device according to the manufacturer’s directions.

Change administration sets, using aseptic technique, no more often than every 96 hours without fat emulsion and immediately upon suspected contamination or when the integrity of the product or system has been compromised to help reduce chance of bacterial growth. Administration sets that have been used for PN and have a piggybacked IVFE must be changed every 24 hours. When IVFE is administered intermittently, use a new administration set with each infusion.

6 Connect the tubing to the catheter:

6a Scrub the catheter port with appropriate antiseptic for 15 seconds.

Decreases potential of introducing pathogens because there is a greater potential for pathogen growth and contamination as a result of the dextrose and protein content of the solution.

6b Flush infusion device with normal saline (0.9% NS) and check for patency. If no blood return from central line, notify healthcare provider, follow organizational policy to declot lines if central line is clotted.

Flushing ensures patency of the line and clears any medication from the line. Central lines should have a blood return, or confirmed patency before each use.

6c Secure the tubing to device as appropriate or recommended by the manufacturer. All administration sets are Luer-Lok design.

6d Ensure that all the connections are secure.

7 Initiate infusion by setting electronic infusion device to ordered flow rate. Start the infusion device.

Ensures accurate delivery of the solution.

8a Infuse over allocated time period; infusions may be started over a longer time (16-18 hours) and decreased down to 8-10 hours following the healthcare prescriber’s orders.

Allows body to adapt to metabolizing increasing amounts of dextrose.

KidKare Administer parenteral nutrition during the night whenever possible so that the child will be free of the tubing and infusion device during the day. This enables child to more readily engage in developmentally appropriate activities and lead a more normal lifestyle.

8b Gradually increase flow rate at initiation of high concentrations of dextrose and protein.

Prevents hyperglycemia.

9a Monitor child regularly during infusion for

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  Metabolic complications: hypoglycemia, hyperglycemia, electrolyte imbalances, azotemia, carbon dioxide retention

  
  
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  Catheter-related problems: breakage, dislodgment, occlusion

  
  
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  Infectious complications: localized site infection, sepsis

  
  
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  Monitor vital signs every 4 hours or as needed.

Enables prompt detection of complications.

9b Monitor blood glucose as ordered by the healthcare prescriber. Contact the healthcare prescriber if blood glucose is abnormal.

The body adapts to high dextrose concentrations by producing increasing amounts of insulin, when the administration of the high dextrose concentration is suddenly interrupted, the child could experience hypoglycemic episodes because it takes time for the body to react to the change.

If high-glucose infusion is suddenly interrupted, be prepared to administer a 5%-10% dextrose solution to the child until the highglucose solution infusion can resume.

10 Decrease infusion rate gradually at end of infusion, as ordered.

Enables body to adjust to decreasing dextrose levels; prevents hypoglycemia.

11a Once infusion is complete, turn off the infusion device.

11b Disconnect and discard tubing.

11c Scrub the catheter port with appropriate antiseptic.

Reduces the risk for transmission of pathogens into the line.

11d Flush the catheter with normal saline, amount dependent on the child and catheter size.

Clears line of dextrose solution, which could potentially cause occlusion or be a growth medium for bacteria.

12 Dispose of equipment and waste in appropriate receptacle. Perform hand hygiene.

Standard precautions. Reduces transmission of microorganisms.