Which of the following complications can be seen in patients receiving total parenteral nutrition (TPN) at th… - RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Medical & Surgical Nursing

Medium

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Explanation

Air embolism is a life-threatening complication that can occur when a central venous access device (CVAD) is open to air.
During a tubing change, the system is temporarily disconnected, creating a direct port of entry for air into the bloodstream.
The negative pressure within the chest cavity, especially during inspiration, can suck air into the large central veins, leading to an embolism that can obstruct blood flow in the heart or lungs.
This risk is specific to procedural manipulations like tubing or cap changes, unlike other complications that occur at different stages of TPN therapy.

Option A: Pneumothorax is a mechanical complication related to the initial insertion of the central venous catheter, not a subsequent tubing change. It occurs if the needle or catheter accidentally punctures the pleura of the lung.
Option B: Hypervolemia, or fluid overload, is a complication related to the rate of TPN infusion. It happens if the solution is administered too quickly, overwhelming the patient's circulatory system.
Option D: Metabolic derangements, such as hyperglycemia, hypoglycemia, and electrolyte imbalances, are ongoing risks throughout TPN therapy. They are caused by the high concentration of glucose and other nutrients in the solution, not by the physical act of changing the tubing.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Total Parenteral Nutrition (TPN) as background academic context rather than a clinical decision trigger.
Preventing air embolism is a critical patient safety responsibility for nurses. Meticulous adherence to protocol, such as clamping the line and using the Valsalva maneuver during tubing changes, is non-negotiable.
Nurses must be able to rapidly recognize the signs of an air embolism (e.g., sudden dyspnea, chest pain, cyanosis, hypotension) and initiate immediate life-saving interventions.
What if? If the patient is unconscious or on a mechanical ventilator and cannot perform the Valsalva maneuver, the nurse should time the tubing change to occur at the moment of end-expiration, when intrathoracic pressure is highest, to minimize the risk of air entry.

How to Approach the Question

First, dissect the question to identify the key components: the procedure is 'Total Parenteral Nutrition (TPN)' and the specific timing is 'at the time of tube change'.
Recognize that 'at the time of tube change' points to an acute, procedural risk, not a chronic or ongoing complication of the therapy itself.
Evaluate each option against this specific time frame.
Consider Pneumothorax: This happens during catheter insertion, not a tubing change.
Consider Hypervolemia: This is related to the infusion rate, not the act of changing tubing.
Consider Metabolic derangement: This is an ongoing risk related to the TPN formula.

Concept Tested & Keywords

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