Day 4- TPN Flashcards
What are your indications for parenteral nutrition?
What are CI’s for parenteral nutrition?
What must the osmolality be in peripheral vein vs central vein?
Non function gut(ileus, mechanical obstruction, short bowele syndrome(<100 cm), hypoperfusion(MAP <70), severe radiation enteritis, distal high out put fistulas(>500mL/day), unable to tolerate EN/establish access for EN.
Hemodynamic instability, functioning GI tract without adequate trial of EN, prior to correction of abnormalities in electrolytes, acid/base(relative).
<900 mOsm/L. Central is usually hyperosmolar(>1300mOsm/L).
What veins do you normally give PN access to?
What is central vs peripheral nutrition advantages/dis?
What is Dextrose, protein, fat conversion?
Subclavian vein, Jugular vein, PICC line.
Peripheral is fewer cath related infections but increased extra vasation. Central is flipped.
3.4kcal/g. Protein is 4 kcal/g, Fat is 10 kcal/g.
What is 20 and 30% kcal fat calculation?
How do you determine fats of mixture?
How do you determine what salt you give people in TPN?
2kcal/mL, 2 kcal/mL/
30% of mixture(convert to kcal) TEE.
If Acidotic–> Give as acetate, if Alkalotic give as chloride.
What calcium salt are you going to give?
What phosphate salt is preferred?
What magnesium salt is preferred?
Gluconate salt(reduces preciptate with phosphorus).
sodium
sulfate(can you chloride as well but sulfate preferred)
What type of insulin do you use in PN contents?
What are the differences between premixed and compounded on site TPN’s?
What are the advantages and disadvantages of 3 in 1 solution?
REGULAR INSULIN ONLY.
Premixed is lower cost, easier to store, less infection risk. Compounded is easier to customize and meet nutritional need goals.
Advantages–> Decreased nursing admin time, may have fewer contaminations(fewer infusions), decreased pharmacy prep time, lower cost, improved fat clearance with 24 hour administration. Disadvantages–> more bacterial growth risk( IVFE> TNA> 2 in 1), Almost impossible to see particle contaminants, have to use 1.2 micron filter(won’t filter bacteria), lower solubility of Ca/Phos.
What do you add first out of phosphate or calcium?
What is cracking in emulsion bags?
How do you store TNA?
Phosphate.
Complete separation.
Refrigerate it, stable for 7 days under refrigeration, 30 hours at room temperature.
What are your hang time’s?
Does IVFE alone need to be filtered?
What is your pH standard?
IVFE is 12 hours, 3 in 1 is 24 hours, 2 in 1 is 72 hours.
NO!
7.4
