Place the steps for administering TPN through a central line in the correct order.

• A. 7, 3, 5, 2, 1, 4, 6
• B. 7, 3, 2, 5, 1, 4, 6
• C. 7, 4, 5, 3, 1, 2, 6
• D. 7, 3, 5, 1, 2, 4, 6

Answer: (A)

Starting TPN through a central line is about maintaining sterility, ensuring line patency, and delivering the prescribed nutrition safely. Begin by confirming the physician’s order and the patient’s identity so you’re giving the right solution to the right person. Then perform hand hygiene and prepare a clean, sterile setup to protect against infection. Next, inspect the TPN bag and its labeling—check the expiration date, appearance of the solution, and that it matches what was ordered, including any required additives or filtration.

Ensure the central line is patent and ready for infusion. If flushing is part of the protocol, do a saline flush to clear the line and confirm patency before connecting the TPN. Prime the tubing with the TPN solution so there is no air in the line, preserving a smooth, continuous flow. Connect the tubing to the central line using sterile technique, making sure the lumen is dedicated to TPN and not used for other medications unless explicitly ordered.

Set up the infusion pump and program the prescribed rate, verifying that the rate matches the order and that the bag is hung correctly with proper labeling. Start the infusion and monitor the patient closely for tolerance and potential complications, such as shifts in glucose and electrolyte levels, signs of infection at the catheter site, or catheter dysfunction. Document the procedure, the starting rate, and the patient’s response, and adjust as needed according to monitoring results and orders.