a. A TPN order must be written for each 24 hours of patient
feeding.
b. Orders must be received in the pharmacy no later than
4:00 P.M. daily. Late orders will be placed in a lower priority than other
medication orders. If the next TPN bottle is not available when needed on the
Nursing Unit, a Dextrose 10% Solution will need to be hung until the order is
available.
c. The Pharmacy will provide each TPN fluid in a sequential
number series with the number appearing on the label of the container. Before
hanging a TPN the nurse is to compare the label data to the most recent
physician’s order. Discrepancies or questions are to be directed to the
Pharmacy before the TPN is hung.
d. All TPN solutions will be sent to the nursing unit at
7:00 P.M. and are to be hung at 8:00 P.M. This includes the initial fluid
order.
e. No additional ingredients are to be added without first
contacting the Pharmacy.
f. Normal expiration dating for a TPN fluid is 36 hours
from the time of preparation.
g. TPN orders are not considered to qualify for a "STAT,"
"NOW," or "EMERGENCY" designation. A Dextrose 5% Solution
is to be hung when a new subclavian line is put into place until a chest X-ray
verifies the placement of the catheter in the vena cava. When positioning has
been verified, hang a Dextrose 10% Solution until 8:00 P.M. when the first
unit of TPN fluid is delivered.
h. No TPN order will be prepared if the order is incomplete
or questionable until all information is clarified by a physician.
i. The Pharmacy is to communicate to the nurse any changes
in orders that the physician may make directly with the Pharmacist. The nurse
should make an annotation to the original TPN order and the physician is to
initial the changes as soon as possible.
