TABLE 7-26 Complications Associated with Total Parenteral Nutrition
Problem	Nursing Interventions
Infection
Local infection (pain, redness, edema) Generalized, systemic infection (elevated temperature, WBC)	Sterile dressings; administer antibiotics as ordered; general comfort measures
Arterial Puncture
Artery is punctured instead of vein Physician aspirates bright-red blood that is pulsating strongly	Needle is withdrawn and pressure is applied
Air Embolus
Air enters venous system during catheter insertion or tubing changes; or catheter/tubing pull apart Chest pain, dizziness, cyanosis, confusion	Stat ABGs, chest x-ray, ECG Connect catheter to sterile syringes, and aspirate air Clean catheter tip, connect to new tubing B Place patient on left side with head lowered (left Trendelenburg prevents air from going into pulmonary artery) Prevention: have patient perform Valsalva maneuver or use plasticcoated clamp on catheter at insertion or tubing changes
Catheter Embolus
Catheter must be checked for placement by x-ray and observed when removed to be sure it is intact	Careful observation of catheter Monitor for signs of distress
Pneumothorax
If needle punctures pleura, patient reports dyspnea, chest pain	May seal off or may need chest tubes