Parenteral Flashcards
2 access types
Central
Peripheral
Central access
TPN
Delivery directly into superior vena cava or R atrium
Infusions toxic to small veins
Peripheral access
PPN
Short term (10-14d)
Into peripheral veins - i.e. arms, legs, hands, feet
Low energy + protein to protect vein
Hyperosmolar solutions -> thrombophlebitis
Continuous administration
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
Cyclical administration
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
Long term catheters
Tunnelled catheter
Short term catheters
Non-tunnelled CVCs
PICCS
Medium term catheters
Tunnelled catheters
PICCS
PICC lines
Can remain <1yr with maintenance + no complications
Delivery medication and PN
Long-term or mobile patients
Feeds:
CHO
Glucose
Min = 2g/kg/d
Max = 5g/kg/d
Monitor for hyperglycaemia
Feeds:
Glucose:Fat ratio
Ideally 50:50
60:40 -> 70:30
Feeds:
Lipids
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
Feeds:
Amino Acids
Balanced mixture
1.3-1.5g/kg/d
Excess = increased renal solute load
Vit and min + electrolytes
Lower recommendations as no digestion or absorption
Feeds:
Compounding methods
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
