Total parenteral nutrition (TPN) is associated with a number of possible complications. A serious complication is an air embolus which can be introduced during tubing changes or when the system is exposed to air. This can be prevented by minimizing the exposure time and by the patient performing a Valsalva maneuver. Typical symptoms of an air embolus that the nurse should be aware of are acute onset respiratory distress, pleuritic chest pain, cough and dyspnea. Acute onset whole body petechiae and ecchymosis are findings in disseminated intravascular coagulation, which often are complications seen in bacterial sepsis but not in TPN patients. Diaphoresis and crushing, radiating substernal chest pain is characteristic of an acute myocardial infarction, which is not a complication associated with TPN. Acute onset oliguria, lethargy, malaise, and a rising serum creatinine is seen with acute renal failure, which is not associated with TPN.