*Module 11: Parenteral Flashcards
What is PN?
Parenteral nutrition
PN is a USP 797 CSP Category 2.
What does TPN stand for?
Total parenteral nutrition
What is CPN?
Central parenteral nutrition
Administered through a central line.
What is PPN?
Peripheral parenteral nutrition
Administration through either peripheral venous access or central access.
What are ILE?
IV lipid emulsions
What is 2-in-1 PN?
Dextrose, amino acids, electrolytes, vitamins and minerals in one PN bag
ILE administered separately.
What is 3-in-1 PN?
Total nutrient admixture
All PN macronutrients in the same bag.
What is intralipid?
Soybean oil-based lipid emulsion
Provides linoleic acids and is pro-inflammatory.
What is SMOF lipid?
A lipid emulsion containing soybean oil, medium-chain triglycerides (MCTs), olive oil, and fish oil.
What are the indications for PN?
Impaired absorption of nutrients or increased loss of nutrients, mechanical bowel obstruction, need for prolonged bowel rest, motility disorders, inability to maintain sufficient oral or enteral access.
What is a macronutrient complication of PN related to hyperglycemia?
Target BG range is 140-180 mg/dL
Monitor glucose infusion rate and consider insulin regimen.
What should be done if hypoglycemia occurs due to abrupt discontinuation of PN?
Begin dextrose infusion and continue for 1-2 hours following discontinuation.
What is essential fatty acid deficiency?
Can occur within 1-3 weeks in adults receiving ILE-free PN.
What is the solution for hypertriglyceridemia in PN?
Hold ILE from PN regimen if serum TG concentration is >400 mg/dL.
What are the normal BUN and sCr levels?
BUN: 7-18 mg/dL, sCr: 0.6-1.1 mg/dL
Monitor trends and decrease AA content as needed.
What is steatosis in relation to PN?
Modest elevations of serum aminotransferase concentrations that can occur within 2 weeks
May return to normal, even if PN is continued. Solution: decrease caloric load of PN.
What is PN-associated cholestasis (PNAC)?
Elevation of alkaline phosphatase and gamma-glutamyl transpeptidase (GGT), conjugated bilirubin: >2 mg/dL
If using 100% soybean-based ILE, do not exceed 1 g/kg/day. Consider change in ILE to mixed oil source and decrease caloric load of PN.
What is the solution for gallbladder sludge/stones in PN?
If able to provide any nutrition via enteral route, will benefit by allowing for release of CCK.
What is a micronutrient complication related to fluids and electrolytes?
Fluids and electrolyte replacement with separate IV fluids outside of the PN formulation may be necessary when the patient has excessive losses.
What micronutrient complication is associated with fat-soluble vitamins?
Excessive intake of fat-soluble vitamins A, D, E, K has potential for accumulation and toxicity
Standard daily multivitamin to prevent deficiencies. Monitor anticoagulation levels of patients on warfarin.
What trace element deficiencies may occur in long-term PN?
High intestinal losses may require more zinc, selenium deficiency may induce cardiomyopathy, and patients on long-term PN may develop manganese toxicity
Additional losses from CRRT.
What are the calorie requirements for stable patients?
20-30 kcal/kg/day
What are the calorie requirements for critically ill patients, trauma, or sepsis?
25-30 kcal/kg/day
