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Clin 2 > Nutrition Support: PN > Flashcards

Nutrition Support: PN Flashcards

1
Q

What are the indications for PN?

A
  • patient has failed EN with proper tube placement
  • severe acute pancreatitis
  • SBS
  • Inaccessible GI tract (paralytic ileus, mesenteric ischemia, small bowel obstruction, GI fistulas)
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2
Q

What are the 3 infusion routes?

A
  1. peripheral venous access (short-term)
  2. peripherally inserted central catheter (intermediate)
  3. central venous catheter (long-term - surgery required)
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3
Q

What are the 2 infusion solutions?

A
  1. peripheral parenteral nutrition

2. central parenteral nutrition

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4
Q

What are the contraindications to PPN?

A
  • significant malnutrition
  • severe metabolic stress
  • large nutrient or electrolyte needs
  • fluid restriction
  • need for prolonged PN >2 weeks
  • renal or liver dysfunction
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5
Q

What are the complications of PPN?

A
  • phlebitis
  • venous thrombosis
  • thrombophlebitis
  • extravasation
  • occlusion
  • pain
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6
Q

What are the complications of CPN?

A
  • sepsis
  • embolism
  • pneumothorax
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7
Q

What are the 4 formulations for PN?

A
  • dextrose
  • proteins (a.a)
  • intravenous fat emulsions
  • additives (electrolytes, vitamins, trace elements)
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8
Q

Describe the dextrose formulation of PN.

A
  • primary source of energy
  • provides 3.4 kcal/g
  • dextrose concentrations of > 10% are only administered in central veins to avoid thrombophlebitis
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9
Q

What is the maximum tolerance of dextrose in mg/kg and in g in PPN and CPN?

A

3mg/kg/min
PPN: 150-300 g/d
CPN: 150-600 g/d

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10
Q

What is the osmolarity range allowed in PPN and CPN?

A

PPN: 600-900
CPN: 1300-1800

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11
Q

Describe the two different IVFE solutions of PN.

A 
1. Intralipid 
20% soybean
1.2% egg yolk
2.25% glycerin
sodium hydroxyde
2. SMOF
30% soybean
30% MCT
15% fish oil
25% olive oil
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12
Q

What is propofol used for?

A

a lipid-based intravenous anesthetic sedative agent

- 10% fat emulsion

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13
Q

What is the maximum lipid infusion rate?

A

2.5 g/kg/d
1.7 mg/kg/min
up to 30% of total kcal

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14
Q

What is xerosis caused by?

A

deficiencies of vitamin A, EFA, zinc

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15
Q

What are the two common amino acid solutions?

A
  1. Travasol - no electrolytes - 10% stock

2. Aminosyn - no electrolytes - 8.5% & 10%

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16
Q

What are the pros and cons of the 2-in-1 solution?

A

pros:

  • more stable
  • less risk of bacterial contamination
  • longer hang times

cons:

  • faster infusion rate of fat can lead to hyperTG
  • more nursing time is required
  • additional IV tubing for lipid
17
Q

What are the pros and cons of the 3-in-1 solution?

A

pros:

  • low cost
  • low nursing time
  • less manipulation -> decrease risk of contamination
  • fat clears better when administered >12h

cons:

  • requires larger pore size filter (fat instability risk)
  • higher incidence of medication incompatibility with fat
18
Q

What are the infusion times (rates)?

A

day 1: 50 ml/h
day 2: 75 ml/h
day 3: 125 ml/h

19
Q

What are the two methods of calculating osmolarity?

A 
1. 
5 x g CHO
10 x g PRO
\+300-400 for electrolytes
\+300 for IVFE
2. 
50 x L CHO
100 x L PRO
\+300-400 for electrolytes
\+300 for IVFE
20
Q

What are the short-term and long-term complications of PN?

A

Short-term:

  • hyperglycemia
  • refeeding syndrome
  • azotemia

Long-term:

  • vascular access sepsis
  • hypertriglyceridemia
  • hepatobiliary complications (steatosis, cholestasis, gallstones)
  • metabolic bone disease
21
Q

What is the cause for hyperglycemia in PN and what is the main treatment?

A
  • Stress in critically ill and CHO overfeeding, which leads to insulin resistance
  • Insulin therapy, standard insulin
22
Q

What is the cause for hyperTG and how is it managed (+goal)?

A
  • Caused by CHO overfeeding or rapid IVFE infusion rates (>0.11 g/kg/h)

Managed by:

  • reducing dose and/or increasing infusion time
  • could use <30% of total energy or 1 g/kg/d
  • Goal: TG <4.52 mmol/L (400 mg/dL)
23
Q

What is azotemia? What can it result from? What can it benefit from?

A

Elevation of BUN and creatinine levels

Can result from:

  • excessive protein administration
  • dehydration
  • inadequate nonprotein energy
  • Impaired ability to clear urea

Can benefit from:
- a reduction in aa and the use of hepatic disease formulations (high BCAA and low AA)

24
Q

What are the 9 things that should be monitored in PN?

A
  • fluid intake and output
  • weight
  • body temp
  • glucose tolerance
  • electrolytes
  • hepatic function
  • visceral proteins
  • CRP
  • N balance

Clin 2 (11 decks)

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