Week 4 CVAD and TPN Lab Template STUDENT 2024

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Toronto Metropolitan University *

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221

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Mechanical Engineering

Date

Feb 20, 2024

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docx

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Week 4 CVAD and TPN Student Lab activity Demonstrate knowledge application of principles related to TPN administration Students will demonstrate how to set up TPN transfusion working in pairs (if applicable) Engage in an activity, located at the bottom of this page, to gain insight into how to read a TPN prescriber order and answer relevant questions Demonstrate accurate documentation and reporting Prepare a ISBARR/handover report focusing on the TPN order for your colleague who will be taking over your patients care at the end of this shift Back prime secondary line and Infuse secondary IVPB by gravity (15 min) Demonstrate back priming and setting secondary rate Practice for IV skills testing. Total Parenteral Nutrition (TPN) CVAD activity Optional Case study Autumn, age 32, has a history of Diabetes Mellitus Type II and has been admitted to the hospital with a left lower leg wound that developed cellulitis. She has been receiving antibiotic therapy in the hospital for the past two days through a right upper arm PICC line and is now ready for discharge. When at home, she will continue to receive cefazolin 500 mg IV every 8 hours for the next 14 days. 1. What will you provide for patient education for Autumn regarding her PICC line? 2. What are the maintenance care priorities for care of the PICC line? 3. Are there any specific concerns related to Autumn’s need for a PICC line that should be monitored or addressed? Objective Student Goals Demonstrate knowledge application of principles related to the care of clients with a CVAD Assess the site of a peripheral IV/CVAD for complications and identify nursing actions. Identify documentation requirements. Demonstrate accurate documentation and reporting Prepare a /handover report focusing on the newly inserted PICC line for your colleague who will be taking over your patients care at the end of this shift

4. What is the purpose of the PICC line? 5. How often should a PICC line be assessed? 6. How does the dressing get changed for a PICC line? - ● practice a PICC line change 7. What makes a PICC line different from a peripheral IV and from an implanted port? ● Review different CVAD devices and locations of insertion. https://wtcs.pressbooks.pub/nursingadvancedskills/chapter/4-8-learning-activities/ NSE 221 - TPN Activity Instructions: You will need the TPN doctor’s order sheet (separate document) and the 2 labels found at the bottom of this page to answer these questions. 1. From the Doctor’s Orders for the TPN, determine which bag of amino acids is the correct bag to hang based on the day today. 2. What is the difference between the two bags of amino acid solution and how did you determine which one should be hung at the present time? 3. Read the Doctor’s Orders for the amino acids and answer the following: a. At what rate should the TPN amino acids be run? b. At what rate (drops per minute) should the TPN be set if you were running it by gravity? (Assume a drip factor of 15 gtts/min.) c. At this rate, how long will it take for the whole bag to infuse? When will the bag be finished if hung now?

4. Read the Doctor’s Orders for the lipids and answer the following: a. What is the rate (mL/hr) at which the lipids should be run? b. At what rate (drops per minute) should the TPN be set if you were running it by gravity? (Assume a drip factor of 15 gtts/mL.) c. At this rate, how long will it take for the whole bag of lipids (500mL) to infuse? When will the bag be finished? 5. On what kind of IV line should the TPN be run? Explain why.

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BAG LABEL 1 VOL: 1500ML RATE:_________________ 5% AA / 16.6% DEX W ELECT TPN 1000 ML SODIUM CHLORIDE 40 MMOL POTASSIUM CHLORIDE 20 MMOL CALCIUM GLUCONATE 10% 2.3 MMOL MAGNESIUM SULFATE 2.5 MMOL VITAMINS MULTIPLE 10 ML TOTAL TRACE ELEMENTS 5 ML RANITIDINE 66.7 MG ***CENTRAL LINE ONLY *** TOTAL SODIUM: 75 MMOL TOTAL POTASSIUM: 50 MMOL TOTAL CALCIUM: 2.3 MMOL TOTAL MAGNESIUM: 5 MMOL TOTAL PHOSPHATE: 15 MMOL TOTAL RANITIDINE: 66.7 MG (= 100 MG/24H) BAG # 1 DUE: USE BEFORE:

BAG LABEL 2 VOL: 1500ML RATE:_________________ 5% AA / 16.6% DEX W ELECT TPN 1000 ML SODIUM CHLORIDE 40 MMOL POTASSIUM CHLORIDE 20 MMOL CALCIUM GLUCONATE 10% 2.3 MMOL MAGNESIUM SULFATE 2.5 MMOL VITAMINS MULTIPLE 10 ML TOTAL TRACE ELEMENTS 5 ML VITAMIN B1 100 MG VITAMIN K1 10 MG RANITIDINE 66.7 MG ***CENTRAL LINE ONLY *** TOTAL SODIUM: 75 MMOL TOTAL POTASSIUM: 50 MMOL TOTAL CALCIUM: 2.3 MMOL TOTAL MAGNESIUM: 5 MMOL TOTAL PHOSPHATE: 15 MMOL TOTAL RANITIDINE: 66.7 MG (= 100 MG/24H) BAG # 2 DUE: USE BEFORE:

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