General Nursing (RGN)
PARENTERAL NUTRITION (PN)
Parenteral nutrition provides prescribed nutrients intravenously when the gastrointestinal tract cannot safely meet nutritional needs. It requires strict product and patient verification, aseptic central-line care, an infusion pump, glucose and electrolyte monitoring, and vigilance for metabolic, infectious, and catheter-related complications.
Purpose
- Provide energy, protein, electrolytes, vitamins, and trace elements intravenously
- Support patients who cannot use the gastrointestinal tract adequately
- Promote metabolism, tissue repair, and recovery while enteral nutrition is unsuitable
Indications
- A documented prescription for peripheral or total parenteral nutrition
- Intestinal failure, severe malabsorption, bowel rest, or inability to meet needs enterally
- A patient assessed by the nutrition and medical team as requiring PN
Equipment
- Prescribed PN bag and administration record
- Appropriate central or peripheral venous access
- Infusion pump and dedicated administration tubing
- Correct in-line filter according to solution and local policy
- Alcohol or approved antiseptic for hub care
- Sterile gloves, mask, gown, cap, and PPE as required
- Blood-glucose and vital-sign monitoring equipment
- Emergency supplies and documentation record
Preparation
- Review laboratory results and the nutrition plan, and ensure replacement PN and dextrose support are available if required by policy.
- Confirm the patient and family understand the purpose, monitoring, mobility precautions, and symptoms to report.
Procedure steps
- Review the prescription, patient identity, indication, access route, solution composition, rate, additives, expiry, and storage requirements.
- Compare the PN label with the prescription and patient wristband using independent checks; inspect for leaks, particles, separation, or unexpected colour change.
- Allow refrigerated PN to reach the approved temperature without unsafe heating; do not use a compromised or expired bag.
- Assess the patient, baseline vital signs, fluid status, glucose, electrolytes, catheter site, and line patency according to the care plan.
- Perform hand hygiene and prepare the pump, tubing, filter, and dedicated line using aseptic technique; prime the tubing without introducing air.
- Don appropriate PPE, disinfect the catheter hub for the specified contact time, and connect the PN using sterile non-touch technique.
- Program and start the infusion at the prescribed rate; use the dedicated lumen and do not abruptly increase or stop without a clinical plan.
- Monitor hourly or as policy directs for pump function, line integrity, glucose, fluid balance, electrolyte symptoms, fever, chills, dyspnoea, and catheter-site changes.
- Change the bag and tubing, flush or lock the line, and taper the infusion only according to the prescription and facility policy to reduce rebound hypoglycaemia.
- Document the solution, checks, rate, access site, monitoring, patient response, and any complication or escalation.
Precautions
- PN is a high-alert therapy; use independent verification and never alter the bag or rate without authorization.
- Maintain strict asepsis and a dedicated lumen; do not use the PN line for incompatible medicines or blood sampling unless policy permits.
- Do not stop a continuous PN infusion abruptly without an approved alternative and monitoring plan.
- Report fever, rigors, hyperglycaemia, hypoglycaemia, new dyspnoea, oedema, electrolyte symptoms, or catheter malfunction urgently.
Aftercare
- Secure the line and pump, maintain the prescribed rate, and inspect the site and patient during and after bag changes.
- Provide oral or enteral intake only if prescribed and continue mouth care even when oral feeding is restricted.
Documentation
- Record prescription verification, bag details, route and lumen, rate, filter, start and finish times, glucose, observations, intake-output, and tolerance.
- Document line-site assessment, bag or tubing changes, interruptions, complications, and notification of the clinical team.
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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