Ch. 21 Parenteral Nutrition

Question 1

What is ASPEN?

Answer 1

American Society for Parenteral and Enteral Nutrition Support

Have taken extra training in nutrition support

Dietitians, pharmacists, nurses, doctors belong to this organization

Question 2

What is CNSC?

Answer 2

Certified Nutrition Support Clinician

Credentialed exam beyond regular career exam

Question 3

What is Parenteral Nutrition (PN)? [Strategy #3]

Answer 3

Dates back to 1960s

Delivery of nutrient solutions directly into vein, bypassing the GI tract

So, deliver macronutrients and micronutrients into large vein –> volume of blood flow sufficient to immediately dilute solution

This is NOT your simple IV

Question 4

Define: TPN, CPN, and PPN

Answer 4

TPN: total parenteral nutrition
CPN: central parenteral nutrition
*CPN and TPN are talking about the same thing: feeding through a central vein

PPN: peripheral parenteral nutrition
–feeding through peripheral veins

Question 5

Who are candidates for PN?

Answer 5

-No functioning GI tracts and malnourished/at risk for becoming malnourished

• Could be harmed if GI tract used
• ->ex: required bowel rest due to severe tissue damage
• Severe GI bleeding
• High-output fistulas
• Paralytic ileus
• Intractable (uncontrollable) vomiting or diarrhea
• Complete intestinal obstruction
• Severe malabsorption
• Major bowel resection

Question 6

What are fistulas?

Answer 6

Abnormal passage between organs or tissues (or between an internal organ and the body’s surface) that permits the passage of fluids or secretions

Question 7

Where do you access peripheral veins for PPN?

Answer 7

small vein typically through the arm

Question 8

PPN vs TPN and CPN

Answer 8

PPN:

• -Short term (7-10 days): veins can’t handle prolonged use
• -NOT indicated for: high energy requirements, weak peripheral veins, fluid restrictions

TPN and CPN:

• -uses larger, central veins (ex. superior vena cava)
• -volume greater and nutrient concentrations not necessarily limited

Question 9

What nutrients are provided in PN?

Answer 9

Macronutrients
Micronutrients
Vitamins
Minerals

Question 10

Macronutrients in a Parenteral Solution

Answer 10

AA: 4 kcal/g

CHO = dextrose = 3.4 kcal/g
–one of your major energy sources

Lipids:

• -10% provides 1.1 kcal/mL
• -20% provides 2.0 kcal/mL
• -30% provides 3.0 kcal/mL

Question 11

Micronutrients in a Parenteral Solution

Answer 11

Electrolytes:
–major minerals: sodium, potassium, chloride, calcium, magnesium, phosphorus

Trace minerals:

• -zinc, copper, chromium, selenium, manganese
• -IRON: NOT given in the solution (separate injection) [iron alters stability of other nutrients]

Vitamins:

• -multivitamins (MVI) need to be provided
• -NO vitamin K for patients on Coumadin

Question 12

Transitional feeding options

Answer 12

1. TPN –> PO
2. TPN –> enteral –> PO
3. TPN + enteral –> PO