ASPEN Self-Assessment: Complications of PN Flashcards
What contributes to metabolic bone disease in PN-dependent patients?
Aluminum toxicity
(TRUE/FALSE)
Hyperglycemia causes a shift of water out of the cells into the extracellular space, resulting in dilution of serum sodium
TRUE; resulting in hypertonic hyponatremia
For every 100 mg/dL increase in serum glucose conc above 100 mg/dL, the serum sodium would be expected to DECREASE by approximately 1.6 mEq/L.
Treatment should consist of correction of the underlying hyperglycemia, and NOT changes in sodium and water administration, as this is not a true sodium or water imbalance.
Define azotemia
an elevation in BUN and serum creatinine levels
(TRUE/FALSE)
If serum TG is above 400 mg/dL, the ILEs should be discontinued.
TRUE.
Provide lipids only to prevent EFAD.
Parenteral nutrition should not exceed X mg/kg/min or X to X kcal/kg/day.
Not exceed 5 mg/kg/min OR 20 to 25 kcal/kg/day
When fibrin builds up inside the vein and causes the vascular access device to adhere to the vessel wall, what is it called?
Mural thrombus
A layer of fibrin that develops around the outside of the CVC (central venous catheter) secondary to aggregation of fibrin from the presence of a CVC within a vein, is?
Fibrin sheath
What is fibrin build up on the CVC tip that will allow for infusion through the CVC, but will inhibit withdrawal of blood?
Fibrin tail/flap
What is a clot within the catheter lumen and is caused by inadequate flushing and blood reflex?
Intraluminal thrombus
0.1N HCl acid is most effective for clearing catheter occlusions due to precipitation of?
Calcium-Phosphate
However, direct infusion of HCl acid into the venous system can be associated with fever, phlebitis, and sepsis
What catheter occlusions is sodium bicarbonate been effective in clearing?
Catheter occlusions due to precipitates associated with meds in the high pH range (tobramycin and phenytoin).
What is 70% ethanol effective in clearing in catheter occlusions?
Dissolve lipid residue
What is the most important contributor to metabolic bone disease?
Negative calcium balance.
Hypocalcemia occurs as a result of decreased calcium intake and/or increased calcium urinary excretion.
Factors that cause:
- Excessive calcium & inadequate phosphorus supplementation
- Excessive protein in PN solutions
- Cyclic PN infusions
- Chronic metabolic acidosis
What is the most appropriate intervention for hypercalcemia?
Protein reduction; specifically protein doses for long-term PN should not exceed 1.5 g/kg/day
(TRUE/FALSE)
Oral or enteral feeding, even in small amounts, is the best approach to preventing cholelithiasis.
TRUE, (gallstones) as it stimulates cholecystokinin secretion, bowel motility and gallbladder emptying.
What is ursodiol?
Used to dissolve gallstones; and shown to improve bile flow
However, it has limited results and is only available in an oral dosage form and its absorption may be limited in patients with intestinal resection.
(TRUE/FALSE)
Supplementation of choline has been shown to prevent cholelithiasis.
FALSE
The role of choline in the pathogenesis of cholelithiasis has not been determined
Acetate is metabolized to what?
Bicarbonate
So excessive use of acetate may precipitate a metabolic alkalosis.
(TRUE/FALSE)
Excess chloride is a common cause of metabolic acidosis.
TRUE
As well as, diarrhea and ARF
(TRUE/FALSE)
Severe hypophosphatemia has been reported to cause respiratory failure and seizures?
TRUE
What are the recommended maximum amounts of PN components per clinical guidelines for adults?
- mL/kg/day of Fluid
- g/kg/day of CHOs
- g/kg/day of Fat
- g/kg/day of Protein
30 to 40 ml/kg/day of Fluid
7 g/kg/day of CHOs
2.5 g/kg/day of Fat
2 g/kg/day of Protein
What are some contraindications for PPN?
- Signification malnutrition
- Severe metabolic stress
- Large nutrient or electrolyte needs
- FR
- Greater than 2 weeks need for PN support
- Liver and Renal compromise
What feature of Groshong CVC reduces the risk of catheter occlusion?
A pressure-sensitive three-way valve that restricts blood backflow and air embolism by remaining closed when not in use.
This eliminates the need for heparin flushes to maintain catheter patency, but the CVC should be flushed with NS after med administration or blood aspiration to ensure the valve is in the closed position.
What is Alteplase?
Is the only FDA-approved thrombolytic agent for CVAD occlusion
Alteplase 2 mg in a 2-mL volume is injected into the catheter and allowed to dwell for 30 minutes to 4 hours, then aspiration of solution with a syringe is attempted. The process may be repeated, if necessary.
(TRUE/FALSE)
Use of heparin 100 units/mL is appropriate for the treatment of CVAD occlusions.
FALSE
Heparin is appropriate for catheter FLUSHING
Symptoms of manganese toxicity are associated most commonly with the accumulation of the mineral in which organ?
Brain
Manganese absorption from the GI tract is 6-16% of dietary intake; therefore, when provided through PN there is 100% bioavailability.
Manganese is primarily excreted in the feces via bile
Also, 60-80% of manganese is contained in RBCs.
(TRUE/FALSE)
Hypothyroidism is a secondary cause of osteoporosis.
FALSE
HYPERthyroidism
What is the prime indicator (lab value) for cholestasis?
Serum conjugated (direct) bilirubin
If a patient on long-term PN develops hepatic dysfunction, what two trace elements should be monitored?
Manganese and copper, on a regular basis, and may need to be removed from PN solution if serum levels are elevated
Symptoms of SOB, cough, cyanosis of the face, neck, shoulder, and arms, indicates which device complication?
Superior vena cava syndrome
Define sentinel event.
A patient safety event of an unexpected occurrence involving death or serious physical/physiological injury, or the risk thereof.
Serious injury specifically includes loss of limb OR function.
These are examples of??
- Medication errors
- Wrong-site surgery
- Restraint-related deaths
- Blood transfusion errors
- Preoperative/postop complications
Sentinel events
A scientific basis that focuses on a process that leads to a certain outcome, is?
Process measure
An evaluation of processes or outcomes of care associated with the delivery of clinical services, is?
Clinical measures
Quality measures that emphasize research, proximity, accuracy, and adverse effects in order to result in positive patients outcomes, are?
Accountability
(TRUE/FALSE)
Prophylactic use of antibiotic ointment at the catheter exit site is recommended for preventing catheter-associated sepsis?
What about antibiotic prophylaxis during catheter insertion?
FALSE
Abx ointment only encourages the development of resistant flora and should be avoided
FALSE, abx have not been demonstrated to reduce the incidence.
What are the 3 research recommendations as primary interventions for reducing risks of CVAD-related infections?
- Using the maximal barrier technique during catheter insertion
- Cleansing insertion sites with 2% chlorhexidine preparation
- Education and training of health care personnel
What are 3 signs of a catheter-related bloodstream infection?
- Bacteremia/fungemia with at least 1 positive blood culture
- Clinical manifestations, such as fever
- No apparent source except the catheter
**They often present WITHOUT redness or purulence (pus) at the catheter site
What is Malassezia furfur?
A yeast
Classically associated with superficial infections of the skin and associated structures
Occurs most commonly in premature infants and patients receiving PN containing ILE\
Treatment:
- Antifungal
- D/C ILE
- Removal of the intravascular catheter (especially with non-tunneled catheter infections)
What are these hallmark symptoms of (arm, shoulder or neck swelling, limb, jaw, or ear pain, and dilated collateral veins over the arm, neck, or chest) typically indicate?
Catheter-related central venous THROMBOSIS
