Nutrition

Question 1

What is a major risk of TPN?

Answer 1

Thrombosis (TPN is highly thrombogenic this is why it is delivered into RA via PICC or Hickman to ensure quick dilution)

Question 2

What monitoring is required for patients on TPN?

Answer 2

• 3x weekly blood tests (K+, PO4-, Mg2+)
• Weekly zinc
• Weight
• Fluid balance

*NOTE: pts on TPN often don’t need additional fluids

Question 3

If a pt on TPN develops pyrexia, what should you do?

Answer 3

Must consider whether pyrexia due to line infection or whether due to other cause hence:

• Stop TPN for 30 mins and monitor temperature (if it goes down and then goes up when you restart it suggests line infection)
• Blood cultures (CVC and peripheral)
• Consider other sources of infection and relevant investigations

Question 4

Remind yourself of daily fluid and vitamin requirements per day

Answer 4

Question 5

NICE fluids algorithm

Answer 5

• *Lecture said shouldn’t be having >1 0.9% NaCl per day*
• *Remember potassium can be lost via vomiting and via stomas*

Question 6

If K+ is persistently low, what should you check?

Answer 6

May have hypomagnesaemia and hypokalaemia cannot be corrected if you don’t correct hypomagnesaemia