TPN Tessa — Total Parenteral Nutrition: High Sugar, Central Line, and Never Stop It Suddenly
The bag is nutrition and a sugar load at the same time — stopping it abruptly drops the blood sugar off a cliff
The creamy bag goes up, the pump is set, and Tessa's glucose meter comes out before the first hour passes.
Tessa hangs total parenteral nutrition through a CENTRAL line because the solution is too concentrated for a peripheral vein. Blood glucose is checked regularly — hyperglycemia is common at the start, and abrupt discontinuation causes rebound HYPOGLYCEMIA, so TPN is tapered and never stopped suddenly. If a bag is unavailable, hang dextrose 10 percent as ordered rather than nothing. Infection is the other great risk: strict sterile technique for dressing and tubing changes, tubing changed every 24 hours, and any fever is treated as a line infection until proven otherwise. Never speed up or slow down a bag to 'catch up' — run it on a pump at the ordered rate.
Read TPN Tessa's full story →The story arc
The setup
A client who cannot absorb nutrition through the gut is started on TPN through a central line.
The turn
Two hours in, the client is thirsty and urinating frequently. Glucose: 310.
The crisis
The next bag has not arrived and a nurse suggests just letting the line run dry.
The save
Tessa keeps the rate steady on the pump, uses sterile technique at the dressing, and treats a new fever as a line infection.
NCLEX study section — Total Parenteral Nutrition: High Sugar, Central Line, and Never Stop It Suddenly
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Safety & Infection Control
Take this chapter into practice questions on the same topic.