病人透過中心靜脈導管接受全靜脈營養（TPN）。護理師發現輸注進度比預定慢了 2 小時。哪項行動最合適？
A client is receiving total parenteral nutrition (TPN) via a central line. The nurse notes the solution is running 2 hours behind schedule. Which action is most appropriate?
- ATurn off the pump and restart the infusion關閉輸注泵並重新開始輸注
- BMaintain the current prescribed rate✓ 正解維持目前醫囑規定的速率
- CDouble the rate until the volume is correct將速率加倍直至輸注容量正確
- DIncrease the rate to catch up over the next hour增加速率以在接下來的一小時內追回進度
全靜脈營養（Total Parenteral Nutrition, TPN）是一種透過靜脈輸注提供病人所有營養需求的方式，通常用於無法經口或腸道攝取足夠營養的病人。TPN 溶液含有高濃度的葡萄糖、胺基酸、脂肪乳劑以及電解質、維生素和微量元素，其滲透壓高，對血糖和電解質平衡影響顯著。因此，TPN 的輸注必須嚴格按照醫囑規定的速度進行，以避免血糖劇烈波動和潛在的滲透壓不平衡，對病人造成嚴重代謝併發症。護理師在處理TPN輸注進度落後的情況時，安全考量應優先於追趕進度。
Total Parenteral Nutrition (TPN) is a method of meeting all of a client's nutritional needs through intravenous infusion, typically used for clients unable to obtain adequate nutrition orally or enterally. TPN solutions contain high concentrations of glucose, amino acids, lipid emulsions, electrolytes, vitamins, and trace elements; their high osmolarity has a significant impact on blood glucose and electrolyte balance. For this reason, TPN must be infused strictly at the rate prescribed in order to avoid severe fluctuations in blood glucose and potential osmotic imbalance that could cause serious metabolic complications. When TPN infusion has fallen behind schedule, the nurse's safety considerations must take priority over catching up on the rate.
TPN 的管理原則在台灣和美國是高度一致的。兩地都強調 TPN 輸注速度必須嚴格遵守醫囑，不可任意調整以「追趕」進度，以避免高血糖、低血糖或其他代謝性併發症。護理師若發現輸注異常，應立即通知醫師，由醫師評估後調整處置計畫。中心靜脈導管的照護、感染控制、血糖監測等指引也基本相同。