Parenteral Nutrition

Question 1

What are the indications for parenteral nutrition?

Answer 1

pancreatitis
short bowel syndrome - small intestine is too small so the body does not absorb enough nutrients
burns
ileus - lack of movement in the intestine
obstruction
supplementation - surgery build up

Question 2

What is intestinal failure? What are the different types?

Answer 2

occurs when there is a reduction in gut function below the minimum necessary for the absorption of macronutrients, water and electrolytes such that intravenous supplementation is needed

type 1 - acute, short term and usually self limiting condition
type 2 - prolonged acute condition often in metabolically
type 3 - chronic condition in metabolically stable patients that could be reversible or irreversible

Question 3

What is parenteral nutrition?

Answer 3

feeding of nutritional products to a person intravenously
- intervention for patients where oral or enteral nutrition (EN) cannot be achieved or is not acceptable due to intestinal failure

Question 4

What is intestinal failure caused by?

Answer 4

short bowel
intestinal fistula
intestinal dysmotility
mechanical obstruction
extensive small bowel mucosal disease
congenital defect

Question 5

What are the types of parenteral nutrition bags?

Answer 5

lipid containing bags

aqueous bags with vitamins
- no lipid due to long term problems with the liver

aqueous bags with no vitamins

Question 6

What are multi chamber bags? What are the advantages and disadvantages?

Answer 6

MCBs are available in both triple-chamber (nitrogen, glucose, and lipid) and double-chamber (omitting the lipid) bags
- they isolate the different components of the TPN bag
- plastic seals between the compartments are broken (usually by rolling the bag) in order to mix them just before use

increase stability and shelf life of TPN

imited electrolyte content and the lack of any micronutrients.

Question 7

How can referring syndrome be prevented?

Answer 7

thiamine and vitamin supplements
- vitamin B compound (B1, B2, B3, B6) and thiamine or pabrinex

multivitamin and mineral supplement until on full rate of feeding

have contents of TPN bag gradually increased

Question 8

What are the consequences of refeeding?

Answer 8

neurological - seizures, tremors, encephalopathy

cardiovascular - arrhythmias, hypotension, cardiomyopathy

gastrointestinal - abdominal pain, anorexia, constipation, paralytic ileus, liver failure

metabolic - hypocalcaemia, glucose intolerance , metabolic acidosis

haematological - platelet and leukocyte dysfunction, haemolysis

respiratory - impaired respiratory muscle function

renal - acute tubular necrosis, salt and water retention

Question 9

What should be monitored during parenteral nutrition?

Answer 9

blood glucose
fluid balance charts
weekly weights
renal function
liver function tests
infection markers - CRP, ESR
bone profile - calcium, phosphate
trace elements - zinc, selenium
electrolytes - Na, K, Mg
cholesterol and triglycerides

Question 10

What are the complications associated with parenteral nutrition administration?

Answer 10

insertion related
- pneumothorax (air/gas in the lung cavity), bleeding or misplacement

line complications
- line sepsis, thrombosis, phlebitis (vein inflammation), occlusion or dislodgement/leaking

metabolic (feed) complications
- acute = refeeding syndrome, hypo/hyperglycaemia, acute cholestasis (blocked bile flow)
- chronic = liver disease, metabolic nutrient disease

Question 11

How can parenteral nutrition line occlusion be treated?

Answer 11

possible causes of occlusion are thrombin, particulate debris or lipid particles

drug
- urokinase which is a plasminogen activator allows formation of fibrinolytic protease known as plasmin