Parenteral nutrition: catheter infection and hyperglycemia
Question
Click to highlight the findings that suggest a complication of parenteral nutrition and need follow-up.
0900: Client with Crohn disease is on day 5 of parenteral nutrition through a PICC in the right arm. The client reports chills that began overnight. Temperature is 38.7 C (101.7 F), heart rate 90 beats/min, blood pressure 118/74 mm Hg, SpO2 97% on room air. Fingerstick glucose is 284 mg/dL, up from 138 mg/dL yesterday. The PICC site is red and swollen with yellow drainage. Parenteral nutrition is infusing by pump at the ordered rate. Bowel sounds are present in all four quadrants.
Highlighted phrases are the correct selections.
Answer
chills that began overnight · Temperature is 38.7 C (101.7 F) · Fingerstick glucose is 284 mg/dL, up from 138 mg/dL yesterday · The PICC site is red and swollen with yellow drainage
Rationale
Catheter-related bloodstream infection is a recognized hazard of parenteral nutrition, and the solution itself can let microbes grow. In this client, the overnight chills, the temperature of 38.7 C and a PICC site that is red, swollen and draining all point to that problem and must be reported. A rising blood glucose is both a metabolic complication of the dextrose load and a possible sign of infection. Normal blood pressure and oxygen saturation, a pump running at the ordered rate and present bowel sounds are not the concern here.
Sources
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- Perikabiven (dextrose, soybean oil, electrolytes, lysine, phenylalanine, leucine, valine, threonine, methionine, isoleucine, tryptophan, alanine, arginine, glycine, proline, histidine, glutamic acid, serine, aspartic acid and tyrosine) intravenous prescribing information, Fresenius Kabi USA, LLC
- Clinolipid (olive oil and soybean oil) intravenous prescribing information, Baxter Healthcare Corporation
- Adapted from Open RN Nursing Advanced Skills: Chapter 4 Manage Central Lines
- NutriLipid I.V. Fat Emulsion (soybean oil) intravenous prescribing information, B. Braun Medical Inc.
- Central Line-associated Bloodstream Infection (CLABSI) Basics (Source: CDC)
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