A patient receiving total parenteral nutrition (TPN) via a central venous catheter (CVC) is schedules to receive an intravenous (IV ) antibiotic. Which intervention should the nurse implement before administering the antibiotic?

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This question was previously asked in

SGPGI Staff Nurse Official Paper (Held On: 28 Feb, 2024 Shift 1)

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Answer 1

Correct Answer: Ensure a separate IV access route

Rationale:

Total Parenteral Nutrition (TPN) is a highly concentrated, nutrient-rich solution administered via a central venous catheter (CVC) to provide essential nutrients to patients who cannot eat or absorb nutrients through the gastrointestinal tract.
Administering intravenous (IV) medications, such as antibiotics, through the same lumen as TPN without proper precautions can lead to complications, such as contamination, drug-nutrient incompatibilities, or catheter-related infections.
The best practice is to ensure that a separate IV access route is available for administering the antibiotic, as this prevents mixing of the medication with the TPN solution and eliminates the risk of compatibility issues or adverse reactions.
Using a separate IV access route also reduces the risk of disrupting the continuous infusion of TPN, which is crucial for maintaining nutritional balance in patients reliant on this therapy.

Explanation of Other Options:

Turn off the TPN for 30 minutes

Rationale: Turning off TPN for 30 minutes is not a recommended practice unless specifically instructed by the healthcare provider. Interrupting TPN can cause fluctuations in blood glucose levels and interrupt the patient's nutrient supply, which could lead to metabolic imbalances.
Additionally, turning off TPN does not address the risk of incompatibility between the TPN solution and the antibiotic.

Flush the CVC with normal saline

Rationale: While flushing the catheter with normal saline is an essential step when using a CVC, it is not sufficient to prevent incompatibility between TPN and antibiotics if both are administered through the same lumen.
This option does not address the potential risks of mixing TPN with other medications, which is why a separate IV access route is preferred.

Check for compatibility with TPN

Rationale: While checking for compatibility is a good practice, it is often challenging to determine all possible interactions between TPN and various medications due to the complexity and variability of TPN solutions.
Even if compatibility is confirmed, administering the antibiotic through the same lumen as TPN can increase the risk of catheter-related infections and contamination. A separate IV access is still the safest option.

Conclusion:

The correct intervention is to ensure a separate IV access route for administering the antibiotic. This approach avoids complications related to drug-nutrient incompatibility, maintains the continuous infusion of TPN, and reduces the risk of catheter-related infections. Other options may compromise patient safety or fail to address the underlying risks associated with co-administration of TPN and medications.