Parenteral Nutrition Flashcards
(29 cards)
EN Contraindications
EN is contraindicated
- Bowel obstruction
- Bowel surgery
- Persistient gut dysmotility
- Intractable diarrhea/vomiting
PN Indications
- Can not use EN
- Can be supplemental with EN
- Can not enter into GI tract (Facial injuries, upper GI tract block, severe esophageal varices)
PN may indications
IBD not responding to medical therapy
- Intense chemo with severe mucositis
- Major stress or trauma
PN Contraindications
- GI tract is functional
- Previously well nourished adult, minimal stress, expected to recover < 7 days
- Prognosis does not warrent aggressive therapy
- Risks > benefit
- No venous access
Central Access Devices
- PICC
Peripherally Inserted Central Catheter
- Inserted into peripheral vein –>
central venous system –> Superior vena cava
- Stay in place for 1 year
Central Access Devices
- Short Tern Non Tunneled
Multiple access needs for acute care
- Triple or Double lumen placed
- Jugular, Subclavian, Femoral vessel
- 4-6 weeks only
- High complication risk
Central Access Devices
- Long Term Tunneled
Broviac
- Can be single or millilumen
- Decreased risk of catheter infection
- Easier to care and repair
- Low risk of dislodgement
- Long term / recurring therapy (chemo)
Central Access Devices
- Implanted Catheter
- Attaches to a disk with a self sealing port
- Minimal changes to body image
- Does not require routine site care when not in use
- For infrequent but chronic IV therapy
Peripheral PN
Used more as a bridge
- Does not provide large amount of calories
- Macronutrients can not be adjusted
- Not used in fluid restricted
- Patient must have good peripheral access
- High risk of line thrombosis
Premixed PN
- What is it made up of
Made up of:
- Dextrose
- Amino acids
- Lipids
- Low in sodium potassium, magnesium
Premixed PN
- Pros/Cons
- Cost effective
- Improved patient safety
- Not appropriate for all patients (would not use in patient with low sodium)
Compounded PN
- What is it made up of
Made up of:
- Dextrose
- Amino Acids
- Electrolytes
- Vitamins
- Minerals
- With or without lipids (Ordered and mixed in separatley)
PN Composition
- Carbohydrate
2.5% - 70%
- High dextrose concentration for central PN
- Acidic solution
Provides 3.4 cals/gram
PN Composition
- Protein
Has a buffer (acetate) to counteract any
acids or bases
Also has a balance of essential, semi-essential, and non-essential amino acids
Provides 4 cals/gram
PN Composition
- Lipids
Non-carbohydrate energy source
- Provides essential fatty acids
- Egg yolk phospholipid as emulsifier
- Glycerin to provide isotonicity
Contains small amounts of Vitamin E and K
PN Composition
- Multivitamins
Vitamin K is added separately if indicated due to possible contraindications
PN considerations when adding medications
- Expected therapeutic action of medication
- Physiochemical compatibility and stability within PN mixture
- No other reasonable route of administration
Schedule 1 Medication Additions to PN
H2 Receptor Antagonists
Vitamin K
Regular Insulin
Be careful with adding drugs in PN
- If PN is stopped in then the patient would lose access to medication in PN
Schedule 1 Medication Additions to PN
- H2 Receptor Antagonist
For Stress Ulcer Prophylaxis
Schedule 1 Medication Additions to PN
- Vitamin K
- Contraindicated in history of DVT and warfarin
- Lipids have inherent vitamin K
- Allows easier Blood Glucose management
- Not to be sole glucose control, just meant to counteract dextrose in PN
PN
- Propofol
Usually hold lipids if giving propofol (especially in larger patients)
- Propofol = fat calories
PN
- Expiry Date
Once hung expiry is 24 hours
Lipids have a hang time of 12 hours
Compounded PN is shorter than premixed with no additional additives
Continuous PN
PN infused over 24 hours (lipids are run over 12 hours)
- If its a combination bag that contains lipids within it is good to run for 24 hours
