Parenteral

Question 1

2 access types

Answer 1

Central

Peripheral

Question 2

Central access

Answer 2

TPN
Delivery directly into superior vena cava or R atrium
Infusions toxic to small veins

Question 3

Peripheral access

Answer 3

PPN
Short term (10-14d)
Into peripheral veins - i.e. arms, legs, hands, feet

Low energy + protein to protect vein
Hyperosmolar solutions -> thrombophlebitis

Question 4

Continuous administration

Answer 4

A: well tolerated by most
A: req less manipulation
D: persistent anabolic state
D: altered insulin:glucose ratio
D: increased lipid storage by the liver

Question 5

Cyclical administration

Answer 5

A: ‘normal’ physiology of intermittent feeding
A: maintains N balance
A: ideal for ambulatory patients
D: more manipulation req
D: not tolerated by critically ill

Question 6

Long term catheters

Answer 6

Tunnelled catheter

Question 7

Short term catheters

Answer 7

Non-tunnelled CVCs

PICCS

Question 8

Medium term catheters

Answer 8

Tunnelled catheters

PICCS

Question 9

PICC lines

Answer 9

Can remain <1yr with maintenance + no complications
Delivery medication and PN
Long-term or mobile patients

Question 10

Feeds:

CHO

Answer 10

Glucose
Min = 2g/kg/d
Max = 5g/kg/d
Monitor for hyperglycaemia

Question 11

Feeds:
Glucose:Fat ratio

Answer 11

Ideally 50:50

60:40 -> 70:30

Question 12

Feeds:

Lipids

Answer 12

Energy
TAG (LCT,SCT,mixed) with phospholipid emulsifiers
0.7-1.5g/kg over 12-24hr
Keep TAG <12mmol/L
Limit <1g/kg/d in critically ill

Question 13

Feeds:

Amino Acids

Answer 13

Balanced mixture
1.3-1.5g/kg/d
Excess = increased renal solute load

Question 14

Vit and min + electrolytes

Answer 14

Lower recommendations as no digestion or absorption

Question 15

Feeds:

Compounding methods

Answer 15

TNA or 3 in 1
Optimal N sparing

A: decreased nursing time
A: decreased risk touch contamination
A: easier home administration
A: cost savings

D: limited visual inspection
D: decreased stability + compatability

Question 16

Feeds:

NUTRIflex

Answer 16

Omega (n-3 FAs)
Lipid w/o electrolytes
Lipid special
Lipid plus
Lipid peri

Question 17

Feeds:

Micronutrient balance

Answer 17

Usually N met first

Protein: Fat: Glucose
20 : 30 : 50

Question 18

Complications

Answer 18

Line placement
Thrombosis
Line infections
Metabolic disturbances

Question 19

Allergy

Answer 19

Eggs, soybean, fish, latex, peanuts

Question 20

Other considerations

Answer 20

Shelf life
Storage
Infusion rate
Precipitation

Question 21

Home TPN

Answer 21

Proper selection of patients
Home monitoring protocols
E.g. short bowel syndrome
Tailored to each individual
Bags can be run over 12hr
Several companies offer home packages
Adequate discharge planning/education