Chapter 39: Parenteral Nutrition

Question 2

Describe how parenteral nutrition is administered into the body.

Answer 2

Directly into the bloodstream.

Question 3

List common indications for parenteral nutrition

8,name at least four

Answer 3

*Chronic severe diarrhea and vomiting
*Complicated surgery or trauma
*GI obstruction
*GI tract anomalies and fistulae
*Intractable diarrhea
*Severe anorexia nervosa
*Severe malabsorption
*Short bowel syndrome

Question 4

Discuss how each patient receives their own customized formula and how it is composed by the pharmacist.

Answer 4

Commercially prepared PN based solutions are available. These base solutions contain dextrose and protein in the form of amino acids. The pharmacy adds prescribed electrolytes (eg: sodium potassium, chloride, calcium, magnesium, phosphate), vitamins, and trace elements (eg: zinc, copper, chromium, selenium, manganese) to meet the patient’s needs.

Question 5

Review what sources of carbohydrates and fat are used for parenteral nutrition.

Answer 5

Calories in PN mainly come from carbohydrates in the form of dextrose and by fat in the form of fat emulsion.

Question 6

Central Parenteral Nutrition (Central PN)

Who for, where it’s placed, what type of solution, what it’s made of

Answer 6

• Is indicated when long-term support is needed or when the patient has high protein and caloric requirements.
• We give central PN through a central venous catheter (PICC) whose tip lies in the superior vena cava.
• Central PN solutions are hypertonic, measuring at least 1600 mOsm/L.
• The high glucose content ranges from 20%-50%.
• Central PN must be infused in a large central vein so that rapid dilution can occur.
• The use of a peripheral vein for hypertonic, central PN solutions would cause irritation and thrombophlebitis.

Question 7

Peripheral Parenteral Nutrition (PPN)

Answer 7

Given through a peripherally inserted catheter or vascular access device into a large vein. PPN is used when (1) nutritional support is needed for only a short time, (2) protein and caloric requirements are not high, (3) the risk for a central catheter is too great, or (4) to supplement inadequate oral intake.

Question 8

Define the refeeding syndrome and how it develops in persons receiving parenteral nutrition.

Answer 8

Can occur any time a malnourished patient starts aggressive nutritional support. It is characterized by fluid retention and electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia). Hypophosphatemia is the hallmark of refeeding syndrome. It is associated with serious outcomes, including dysrhythmias, respiratory arrest, and neurologic problems (eg: paresthesias).

Question 9

Review complications of parenteral nutrition related to catheter problems.

Answer 9

Air embolus
Catheter-related sepsis
Dislodgment
Hemorrhage
Occlusion
Phlebitis
Pneumothorax, hemothorax, and hydrothorax
Thrombosis of vein

Question 10

Review complications of parenteral nutrition related to metabolic problems.

Answer 10

Altered renal function
Essential fatty acid deficiency
Hyperglycemia, hypoglycemia
Hyperlipidemia
Liver dysfunction
Refeeding syndrome

Question 11

Estimate reasons that could indicate the need to transition to oral or enteral nutrition, if possible.

Answer 11

If the patient needs continued nutritional support but does not need hospitalization.