Parenteral Nutrition (part 2) Flashcards
Total parenteral nutrition is also known as ____ parenteral nutrition
Central
Total parenteral nutrition is administered via a ____ ___
Central vein
What are some common venipuncture sites for total parenteral nutrition?
-Subclavian
-Internal and external jugular veins
With total parenteral nutrition, the tip is placed in the ____ ____ ____ ____
Distal superior vena cava
Total parenteral nutrition is used for long-term nutrition support for people who require parenteral nutrition for >___-___ days
7-14
Advantages of total (central) parenteral nutrition:
-Due to high blood flow volume and rate, central veins can accommodate the hyperosmolar solutions required to provide adequate nutrition
-Central access is easier to maintain compared to peripheral parenteral nutrition
Disadvantages of total (central) parenteral nutrition:
-Catheter must be inserted by specially trained personnel
-More serious complications
With peripheral parenteral nutrition, peripheral veins are used such as…
-Medial cubital
-Cephalic
-Basilic
Peripheral parenteral nutrition uses smaller veins with lower ____ ____
Blood flow
Indications for peripheral parenteral nutrition:
-Short-term use: less than or equal to 2 weeks
-Patient requires < 2000 kcal/day
Advantages of peripheral parenteral nutrition:
-Peripheral access is easily obtained by nonsurgical personnel
-Decreased risk of serious complications related to placement
Disadvantages of peripheral parenteral nutrition:
-Difficult to maintain access for >3-4 days (may need to frequently change access site)
-Sensitivity of peripheral veins to hyperosmolar solutions (increased risk of phlebitis)
Peripheral parenteral nutrition is limited to less than or equal to _____ mOsm/L, which limits caloric density and protein content of peripheral parenteral nutrition
900
How to calculate the osmolarity for peripheral parenteral nutrition:
-Calculate the osmolarity for each component
-Total the osmolarity for all components
-Divide by the volume of the parenteral nutrition solution in liters
How to calculate the osmolarity for peripheral parenteral nutrition:
-Calculate the osmolarity for each component
-Total the osmolarity for all components
-Divide by the volume of the parenteral nutrition solution in liters
How can we determine the best route for parenteral nutrition?
-Anticipated duration of therapy
-Patient’s nutrient requirements
-Osmolarity of the parenteral nutrition solution
-Condition of the patient’s veins
What are two examples of peripheral vascular access devices?
-Peripheral catheters
-Midline catheters
With peripheral catheters, the catheter is placed in a peripheral vein using standard venipuncture methods at ____ to provide peripheral parenteral nutrition
Bedside
A midline catheter is inserted in veins above the ____ ____ into the basilic or cephalic vein and is extended up for 3-8 inches
Antecubital fossa
The tip of a midline catheter is in the ___ ___
Upper arm
A midline catheter uses a larger vein than a peripheral catheter, which leads to a lower risk of ____ and allows longer dwell times than a peripheral catheter
Phlebitis
A midline catheter can only be used safely for up to ___-___ weeks
2-4
Midline catheters only deliver _____ parenteral nutrition
Peripheral
What are examples of central vascular access devices?
-Short-term central venous catheters
-Peripherally inserted central catheter (PICC line)
-Tunneled catheters
Short-term central venous catheters are used for ___-___ days
7-14
Short-term central venous catheters are inserted at the patient’s bedside by an MD or specially trained RN, so it does not require _____
Surgery
An example of a type of short-term central venous catheter is a ____
Hohn
Short-term central venous catheters can be single or multi-____ catheters
Lumen
Multi-lumen catheters are used to provide access for ____, ____, and ____ without interrupting or interfering with TPN
Medication, blood, and fluids
Multi-lumen catheters also increase the risk for catheter-related ____
Infection
Advantages of short-term central venous catheters:
-Does not require surgery for placement
-Easily removed
Disadvantages of short-term central venous catheters:
-Risk of catheter displacement
-Difficult self-care for patient
-High-risk catheter-related infection and sepsis
Peripherally inserted central catheters (PICC lines) have a peripheral entry site and use a guide wire used to guide the central line into the _____ _____ ____ _____
Distal superior vena cava
Peripherally inserted central catheters (PICC lines) can be used for either ____ or ____ term central access (several weeks to months)
Short or moderate
Peripherally inserted central catheters provide _____ only
TPN
Advantages of peripherally inserted central catheters (PICC lines):
-Lower risk of placement complications
-Does not require surgery
Disadvantages of peripherally inserted central catheters:
-Difficult self care (antecubital placement)
A tunneled catheter is ____ placed and tunneled subcutaneously away from the insertion site
Surgically
Tunneled catheters are used for ____-term access
Long
Examples of types of tunneled catheters:
-Hickman
-Braviac
-Groshong
Advantages of tunneled catheters:
-More secure
-Long-term use
-Easier self-care
-Decreased risk of infection (compared to non-tunneled)
Disadvantages of tunneled catheters:
-Requires surgical placement and removal
____ infusion of parenteral nutrition is running at the same rate non-stop for 24 hours
Continuous
Continuous administration is the most ____ type of administration
Common
Continuous administration is appropriate for:
-New PN orders
-Critically ill patients
Cyclic infusion of parenteral nutrition less than 24 hours, usually ___-___ hours/day
8-12
When would cyclic infusion be used?
-Home TPN
-Transitioning to oral diet
Cyclic infusion is given at a higher rate, so people may have difficulty with ____ ____
Glucose control
2-in-1 formulation with piggyback lipid infusion is when the lipid emulsion is provided in a ____ bag and has its own rate of infusion
Separate
The lipids are “piggybacked” into the ___ ___ that contains the amino acids and dextrose solution
IV line
IV lipids provide a good growth medium for ____
Pathogens
The CDC recommends that the maximum lipid hang time is ____ hours in order to decrease the risk of infection
12
Advantages of 2-in-1 formulation with piggyback lipid infusion:
-Dextrose/amino acids solution is clear so we can see precipitates
-Can discontinue lipid without wasting entire bag of parenteral nutrition
Disadvantages of 2-in-1 formulation with piggyback lipid infusion:
-Increased infection risk due to multiple manipulations at y-connection
-More nursing time and equipment
3-in-1 or total nutrient admixture is when the ____, ____, and ____ are in one bag for IV administration
Carbohydrates, protein, and lipid
Advantages of total nutrient admixture:
-Less nursing, pharmacy time, and equipment
-Fewer opportunities for extrinsic contamination
-Convenience-> home parenteral nutrition
-Continuous 24-hour lipid infusion may enhance lipid oxidation and clearance
-TNA is a poor growth medium for pathogens-> hyperosmolar, acidic
Disadvantages of total nutrient admixture:
-Potentially unstable-> disruption of lipid emulsion
-Impaired visual inspection for foreign particles or precipitates
-Changes in TNA orders may result in wasting
-Filer used with TNA does not remove all particulate matter
-Iron and certain medications are incompatible with he lipid portion of the admixture
