MENDOCINO COAST DISTRICT HOSPITAL
GENERAL PATIENT CARE POLICY AND PROCEDURE STATEMENT
NUMBER: 205.1350
PAGE: 1 OF 3
TITLE: HYPERALIMENTATION
PURPOSE:
To supplement nutritionally compromised patients with a hypertonic mixture of dextrose, amino acids, electrolytes, water, vitamins and trace elements. This solution is tailored to the individual patient’s needs and is administered by central venous catheter. It is often supplemented by peripheral infusion of essential fatty acids in the form of fat emulsion. The goal of nursing care for these patients is to provide the maximum benefits of hyperalimentation and to prevent complications. This is achieved by (1) maintaining aseptic technique during insertion of the catheter and care of the site, tubings and solutions, and (2) ongoing assessment of the patient. The following are guidelines in the case of the patient receiving hyperalimentation.
EQUIPMENT:
Hyperalimentation solutions as ordered by physician and prepared by pharmacy.
IV tubing with 0.22 – micron inline filter.
POLICY:
An RN, following a physician’s specific orders for concentration, rate and additives, can only administer hyperalimentation through a central venous catheter. Blood glucose monitoring must be performed, as ordered by the physician, to provide insulin coverage, if needed, due to the high concentration of dextrose being administered.
Care of the central venous catheter must be performed per policy and procedure. Principles of aseptic technique are to be strictly observed during care of the catheter and changing of the tubing.
The solution and IV tubing must be changed every 24 hours. The solution must be administered via an infusion pump. Lab values must be monitored per physician’s order.
PROCEDURE:
1. Care of Patients During Hyperalimentation
a. Examine site at least every eight hours.
b. Check contents listed on hyperalimentation bottle against chart orders; initial, time and date bottle label. Recheck each shift.
c. Change dressing on central venous site per Policy and Procedure.
d. Hyperalimentation solution is prepared in Pharmacy under laminar flow hood and refrigerated until use. (Bring solution to room temperature prior to administering).
e. Use hyperalimentation catheter only for hyperal infusion. (No I.V. Meds, CVP measurements, blood drawing, etc.)
f. Hang hyperal solution no longer than 24 hours.
g. Regulate infusion rate by infusion pump and check every two hours. Do not speed up or slow rate (“to catch up”) without an order. Sudden increases in rate may cause hyperglycemia; sudden decrease may cause hypoglycemia.
h. If infusion is stopped abruptly, start D/10/W infusion. If central line is discontinued, infuse D/10/W by peripheral vein. This prevents rebound hypoglycemia.
i. Do fingerstick blood sugar every 6 hours, unless ordered differently by the physician. Follow sliding scale for insulin coverage per physician’s orders.
j. Check temperature, pulse and respiration every 4 to 6 hours. Monitor patient for other signs of infection. Assess patient for other sites of infection.
k. In order to monitor fluid balances, record accurate intake and output, and daily weights.
2. Hyperalimentation with Fat Emulsion:
a. Administer fat emulsion by peripheral vein. This isotonic, 10% fat emulsion can be tolerated by peripheral veins. Prevents contamination of hyperal line.
b. Do not mix fat emulsion with drugs, electrolytes or other nutrient solutions.
c. Regulate infusion by infusion pump.
d. Store in refrigerator to prevent growth of contaminants.
e. Change I.V. tubing after infusion.
f. Do not use filter during fat infusion, since the emulsion will clog a filter.
New: Revised: 03/09
Approval Signatures:
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Nurse Manager Date
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Chief Clinical Officer Date
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Medical Chief of Staff Date
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Chief Executive Officer Date
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President, Board of Directors Date