一位病人正經中心靜脈導管接受全靜脈營養（TPN）。目前的藥袋已滴完，但藥劑部尚未送來新的一袋。護理師下一步應採取哪項行動？
A client is receiving total parenteral nutrition (TPN) via a central venous catheter. The current bag is finished, and the new bag is not yet available from the pharmacy. Which action should the nurse take next?
- AInfuse 0.9% Normal Saline at a keep-vein-open (KVO) rate以維持靜脈通路（KVO）速率輸注 0.9% 生理食鹽水
- BCap the central line until the new TPN bag arrives封閉中心靜脈導管直到新的 TPN 藥袋送達
- CHang a bag of 10% dextrose in water (D10W) at the same rate✓ 正解以相同速率掛上 10% 葡萄糖水（D10W）
- DSlow the current infusion rate to wait for the pharmacy減緩目前輸注速率以等待藥劑部
TPN 含有極高濃度的葡萄糖（通常為 15-25%），這會促使胰臟分泌大量胰島素。如果 TPN 突然中斷，體內高水平的胰島素會導致嚴重的『反彈性低血糖』（Rebound Hypoglycemia）。為了預防此致命併發症，當新藥袋延誤時，護理師應掛上含有 10% 葡萄糖的溶液（D10W）以維持血糖。選項 B 和 A 只提供生理食鹽水或封管，無法防止低血糖。選項 D 是錯誤的，因為 TPN 滴注速度應維持恆定，隨意調慢也會導致血糖波動。這題反映了護理師在面對藥物供應延遲時，如何運用病理生理知識來維持病人的內環境穩定。
TPN contains a very high concentration of glucose (typically 15-25%), which stimulates substantial insulin release from the pancreas. If TPN is suddenly interrupted, the persistently high circulating insulin can produce severe rebound hypoglycemia. To prevent this life-threatening complication when a new TPN bag is delayed, the nurse should hang a 10% dextrose in water solution (D10W) to maintain blood glucose. Options B and A provide only saline or cap the line and cannot prevent hypoglycemia. Option D is incorrect because the TPN infusion rate should remain constant—arbitrarily slowing it will cause glucose fluctuations. This scenario reflects how nurses must apply pathophysiologic knowledge to maintain homeostasis when medication supply is delayed.
在美國，這被視為標準的安全協定（Safety Protocol）。台灣臨床實務中，護理師有時會掛 D5W 或 D10W，但部分醫院可能因行政流程而直接改用一般點滴，需注意這在考試中 D10W 才是首選。