Ch 14: Overview of Parenteral Nutrition Flashcards
What AA should be considered as an additive in TPN for patients with pancreatitis?
Consider glutamine to minimize effects of being NPO on GI integrity
What is ASPENs stance on PN in pancreatitis
EN is preferred; PN is unlikely to benefit those with mild, acute, or chronic relapsing pancreatitis when conditions last for less than a week
In a non critically ill patient, when is PN indicated?
PN is indicated in other conditions that preclude the use of the GI tract for more than 7-10 days
What are the indications for starting PN?
Patients who can’t meet need with EN and are malnourished or at risk of becoming malnourished, when placement of EN trial with post pyloric tube fails, paralytic ileus, mesenteric ischemia, SBO, GI fistula (EN may be placed at the end of fistula or if fistula output < 200 mL/d)
What is the difference between permissive underfeeding and hypo-caloric feeding?
Permissive underfeeding meets ~80% of pt’s needs to minimize complications in critical illness
Hypocaloric is used in both EN and PN for obese patients to meet protein requirements but provide less energy then the estimated requirement
As PN formulas are hypertonic, what are some consequences of inappropriate infusion?
Venous thrombosis, suppurative thrombophlebitis, or extravasation (leakage of fluid out of its container)
How long can a CV access be maintained?
Central venous access can be maintained for long periods of time (weeks to years) and is preferred in patients who will require PN for > 7-14 days
In which situations may PPN be appropriate?
Short term duration (< 2 weeks) to provide partial/total nutrition support when patient is not able to ingest adequate energy enterally or orally or when CPN is not feasible
What criteria is usually met in patient’s who are candidates for PPN?
They must have good peripheral venous access and should be able to tolerate large volumes of fluid.
They should require PPN for at least 5 days but less than 2 weeks
When cyclic PN is used, what should be done?
When cyclic PN is used, some form of tapering is usually required during the last 2 hours of the cycle
Can ILE be utilized in PPN?
Yes; ILE may be used to increase energy of PPN w/out increasing the osmolarity and has been reported to improve peripheral vein tolerance of PPN
When PN is indicated in pancreatitis, energy infusion should not exceed what?
When PN is needed, it is recommended that energy administration not exceed 25-35 kcal/kg/day and glucose be controlled
In which situations may PN be beneficial?
PN in the periop patient may be useful in treating malnutrition when other nutrition options are not feasible; max benefit is for severely malnourished patients who receive NS for at least 7-10 days
If PN needs to be stopped emergently what should be done?
A D10% is water solution should be infused at the same rate as PN (or at least 50 mL/h)
What determines the osmolarity of PN?
Dextrose, AA, and electrolyte content
Dextrose contains a~ 5 mOsm/g; AA yield ~10 mOsm per gram; and electrolytes provide ~ 1 M0sm per mEq of individual electrolyte additive.
