How should I monitor a patient receiving total parenteral nutrition for potential complications?

Monitoring a patient receiving total parenteral nutrition (TPN) for potential complications involves regular clinical and biochemical assessments to detect metabolic, infectious, and mechanical issues early.

• Blood glucose should be measured 1 to 2 hours after starting TPN and after each change of the TPN bag, with more frequent checks if there is a history of hypo- or hyperglycaemia, changes in glucose dosage, or clinical concerns such as sepsis or seizures NICE NG154.
• Electrolytes and acid-base balance including blood pH, potassium, chloride, and calcium levels should be monitored daily when initiating or increasing TPN and at least twice weekly once stable; more frequent monitoring is needed if abnormalities or clinical concerns arise NICE NG154.
• Serum triglycerides should be checked daily during lipid dose escalation and weekly at maintenance; more frequent monitoring is warranted if levels are elevated or if the patient is critically ill NICE NG154.
• Serum or plasma phosphate levels require daily monitoring during dose increases and weekly thereafter, with more frequent checks if levels are abnormal or if there are concerns such as metabolic bone disease NICE NG154.
• Liver function tests should be performed weekly, with increased frequency if abnormalities or clinical concerns occur NICE NG154.
• Catheter-related complications must be monitored by healthcare professionals competent in catheter care, including vigilance for signs of infection or mechanical problems, following infection prevention guidelines NICE CG32.
• Clinical assessment should include monitoring for signs of infection, metabolic disturbances, and tolerance to nutrition, with daily review of the patient’s progress and adjustment of TPN accordingly NICE CG32.

Overall, monitoring should be coordinated by a multidisciplinary team with relevant expertise to ensure safe and effective TPN delivery NICE CG32,NICE NG154.