P
arenteral preparations are fluids that
are given either intravenously (IV) or
through a central line.
Therapeutic actions and indications
Parenteral agents are used for the
following purposes: to provide replace-
ment fluids, sugars, electrolytes and
nutrients to people who are unable to
take them in orally; to provide ready
access for administration of drugs in
an emergency situation; to provide
rehydration; and to restore electro-
lyte balance. The composition of
the IV fluids needed for an individ-
ual depends on the person’s fluid
and electrolyte status.
Parenteral nutrition (PN) is the administration of
essential proteins, amino acids, carbohydrates, vitamins,
minerals, trace elements, lipids and fluids. PN is used to
improve or stabilise the nutritional status of cachectic
or debilitated people who cannot take in or absorb oral
nutrition to the extent required to maintain their nutri-
tional status. The exact composition of the PN solution
is determined after a nutritional assessment and must
take into account the person’s current health status, age
and metabolic needs.
Contraindications and cautions
PN is contraindicated in anyone with known allergies
to any component of the solution. (Multiple combina-
tion products are available, so a suitable solution may
be found.) PN should be used with caution in indi-
viduals with unstable cardiovascular status because
of the change in fluid volume that might occur and
the resultant increased workload on the heart. These
preparations also should be used with caution in indi-
viduals with unstable fluid and electrolyte status, who
could react adversely to sudden changes in fluids and
electrolytes.
Adverse effects
Adverse effects associated with the use of PN include
IV irritation, extravasation of the fluid into the tissues,
infection of the insertion site, fluid volume overload,
vascular problems related to fluid shifts and potential
electrolyte imbalance related to dilution of the blood.
Appendix
Parenteral agents
B
PN is also associated with mechanical problems related
to insertion of the line, such as pneumothorax, infections
or air emboli; emboli related to protein or lipid aggre-
gation; infections related to nutrient-rich solution and
invasive administration; metabolic imbalances related to
the composition of the solution; gallstone development
(especially in children); and nausea (especially related to
the administration of lipids).
Clinically important drug–drug interactions
Some IV drugs can be diluted only with particular IV
solutions to avoid precipitation or inactivation of the
drug. A drug guide should be checked before diluting
any IV drug in solution.
Care considerations
Assessment: History and examination
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■
Obtain a nutritional assessment. Screen for any
medical conditions and drugs being taken.
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■
Evaluate the insertion site; skin hydration;
orientation and affect; height and weight; pulse,
blood pressure and respirations; and blood
chemistries, full blood count with differential
and glucose levels.
Implementation
■
■
Assess the person’s general physical condition
before beginning test
to decrease the potential
for adverse effects.
■
■
Monitor the IV insertion site or central line and
regularly consult with the prescriber
to discontinue
the site of infusion and treat any infection or
extravasation as soon as it occurs.
■
■
Follow these administration guidelines
to provide
the most therapeutic use of PN with the fewest
adverse effects:
–– Refrigerate PN solutions until ready to use.
–– Check contents before hanging to ensure that
no precipitates are present.
–– Do not hang bag for longer than 24 hours.
–– Suggest the use of in-line filters to decrease
bacterial invasion and infusion of aggregate.
■
■
Discontinue PN only after an alternative source of
nutrition has been established
to ensure continued
