Parenteral Nutrition Flashcards
Where is the access point in TPN?
Central vein
What type osmolarity solutions can be used with TPN?
High osmolarity
Where is the access point in PPN?
Peripheral vein
What is the osmolarity limit for PPN?
900 mOsm/L
In PPN you want to limit what 2 things?
Dextrose and amino acids
What causes refeeding syndrome?
Too rapid infusion of substrates (particularly glucose) into plasma which causes electrolytes to shift into intracellular spaces as glucose moves into cells
What lab values will be low with refeeding syndrome?
K, Mg, Phosphorus
To avoid refeeding syndrome, what should be administered before feeding?
Thiamine 100mg/day and/or multvitamin and trace elements
To avoid refeeding syndrome, you should start feeds at ____ % of estimate goal (100-150 grams dextrose)
25
IVFE should be held in PN if triglycerides are greater than what?
400 mg/dL
PN shouldn’t be given IVFE if a patient is allergic to what?
Eggs
If blood sugars are >______ PN shouldn’t be started.
300
When transitioning from PN to EN, what should be occuring at 15-20 mL/hour before PN is reduced?
Tube feedings
You can discontinue PN if tube feeding is providing at least ______ % support.
75%
When considering a transition to PO, an individual can stop PN when they have reached a ____% goal.
60%
What may happen if PN is completely stopped?
Rebound hypoglycemia
If TPN needs to be reduced, it should be tapered off at 50% rate for how long?
1-2 hours
For adults with good glucose control you want < ___ mg/kg/min for glucose infusion rate
<5 mg/kg/min
For critically ill adults with glucose intolerance you want <____ mg/kg/min glucose for glucose infusion rate
<3.5 mg/kg/min glucose
Do lipids (IVFE- intravenous fat emulsions) contribute to the osmolarity of a feeding?
No- lipids are isotonic
A patient in moderate stress on PN needs how much protein?
1.5 gm/kg/day
A patient in severe stress on PN needs how much protein per day?
2 gm/kg/day
Why do patients on PN need lower amounts of vitamins, minerals, trace elements.
They bypass the GI
What should be done if abrupt discontinuation is required?
start D10W at rate of TPN for 1-2 hours
What ml/hr should TF be for PN to be reduced?
15-20mL
What level should serum glucose be at for PN?
<150mg/dl
What should oral intake be for transitioning from PN to PO?
500kcal/day
When can you completely stop PN and start PO?
When oral intake is at 60-80% energy goal
What are the medical indications for PN?
paralytic ileus
MEsenteric ischemia
Small bowel obstruction
High output GI fistula
What form of PN should you use if you anticipate PN being longer than 7 days?
TPN
What percentage should CHO make of PN solution and what does that yield in kcal/gram?
5-70%; yields 3.4kcal/gram
What should dextrose infusion be limited to in stabilized hospitalized pts?
<5mg/kg/min
Book states: 7 mg/kg/min
What should dextrose infusion be limited to in critically ill hospitalized pts?
<3.5 mg/kg/min
How many times a week should IVFE be given?
2 times a week
What percentage should amino acids make of PN solution and what does that yield in kcal/gram?
3-20%; yields 4 kcals/gram
What are protein needs for mild stress?
0.8-1 gm/kg/day
To prevent refeeding syndrome, at what goal should you begin to start feeds and what is the time frame for increasing the amount?
25% of estimated goal (100-150 gms/day dextrose)
slowly increase over 3-5 days
