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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

Answer and Explanation

Correct Answer : A,C

Total parenteral nutrition (TPN) requires central venous access and strict aseptic technique because the central line is a major route for bloodstream infections.

Rationale for correct answer:

1. Change the dressing using sterile technique: Sterile dressing changes reduce microbial colonization at the insertion site and lower risk of central line-associated bloodstream infection (CLABSI).

3. Change the TPN tubing every 24 hours: Frequent tubing changes (usually every 24 hours for lipid-containing or TPN administration sets) help prevent microbial contamination and reduce CLABSI risk.

 

Rationale for incorrect answers:

2. Change TPN containers every 48 hours: TPN containers and lipid admixtures are typically changed every 24 hours to limit bacterial growth; leaving containers longer (e.g., 48 hrs) increases infection risk.

4. Monitor glucose levels to watch and assess for glucose intolerance. — Important for metabolic monitoring of TPN (hyper/hypoglycemia) but not a primary intervention to prevent central line infection.

5. Elevate head of the bed 45 degrees to prevent aspiration: Good for aspiration prevention, but unrelated to preventing central line infections.

 

Take home points:

Preventing central line infections centers on aseptic technique:

  • sterile dressing changes
  • proper skin antisepsis
  • hub/port disinfection before access
  • routine tubing/container changes per policy (commonly every 24 hours for TPN).


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Related Questions

Correct Answer is C

Explanation

Gastric residual volume (GRV) is measured to help assess gastric emptying and aspiration risk in patients on enteral feeding. Interpretation depends on the facility’s protocol and accepted thresholds; small residuals are usually acceptable and do not require stopping the feed.

Rationale for correct answer:

3. Continue the feedings; this is normal gastric residual for this feeding: Most clinical protocols consider a GRV of <200–250 mL acceptable and do not require holding feeds.

Rationale for incorrect answers:

1. Assess bowel sounds: Reasonable if you suspect intolerance, but with a GRV of 125 mL (which is below common stop thresholds), immediate assessment of bowel sounds is not the priority action.

2. Raise the head of the bed to at least 45 degrees: Always keep the HOB elevated during enteral feeding to reduce aspiration risk; if not already elevated this is important, but it is not the priority response to a normal GRV of 125 mL.

4. Hold the feeding until you talk to the primary care provider: Not necessary for this residual value and may interrupt nutrition unnecessarily; hold-and-report is usually reserved for higher residuals or signs of intolerance.

Take home points:

  • GRV threshold - common thresholds: 200–250 mL
  • Always keep the head of bed elevated during feedings, monitor for signs of intolerance (abdomen distension, vomiting, aspiration)

Correct Answer is A

Explanation

Delegation is guided by the “Five Rights of Delegation” (right task, circumstance, person, direction, and supervision). In general, APs (assistive personnel) can perform routine, stable, non-invasive tasks.

Rationale for correct answer:

1. Performing glucose monitoring every 6 hours on a stable patient: APs may be trained and delegated to perform point-of-care blood glucose monitoring in stable clients because it is a standardized procedure, and the nurse interprets and acts on the results.

Rationale for incorrect answers:

2. Teaching the patient about the need for enteral feeding: Teaching requires professional nursing knowledge, critical thinking, and individualized instruction. Cannot be delegated to AP.

3. Administering enteral feeding bolus after tube placement has been verified: Feeding via tube involves risk of aspiration and requires assessment and verification skills, which cannot be delegated.

4. Evaluating the patient’s tolerance of the enteral feeding: Evaluation is part of the nursing process (assessment and judgment) and cannot be delegated to AP.

Take home points:

  • APs can perform stable, routine, non-invasive tasks (e.g., vital signs, I&O, ADLs, glucose checks in stable clients).
  • The nurse retains responsibility for tasks involving teaching, assessment, critical judgment, and evaluation

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