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Advanced Medical Nutrition Therapy II > Parenteral Nutrition (part 2) > Flashcards

Parenteral Nutrition (part 2) Flashcards

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USMLE® Step 1 flashcards
1
Q

Total parenteral nutrition is also known as ____ parenteral nutrition

A

Central

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2
Q

Total parenteral nutrition is administered via a ____ ___

A

Central vein

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3
Q

What are some common venipuncture sites for total parenteral nutrition?

A

-Subclavian
-Internal and external jugular veins

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4
Q

With total parenteral nutrition, the tip is placed in the ____ ____ ____ ____

A

Distal superior vena cava

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5
Q

Total parenteral nutrition is used for long-term nutrition support for people who require parenteral nutrition for >___-___ days

A

7-14

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6
Q

Advantages of total (central) parenteral nutrition:

A

-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

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7
Q

Disadvantages of total (central) parenteral nutrition:

A

-Catheter must be inserted by specially trained personnel
-More serious complications

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8
Q

With peripheral parenteral nutrition, peripheral veins are used such as…

A

-Medial cubital
-Cephalic
-Basilic

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9
Q

Peripheral parenteral nutrition uses smaller veins with lower ____ ____

A

Blood flow

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10
Q

Indications for peripheral parenteral nutrition:

A

-Short-term use: less than or equal to 2 weeks
-Patient requires < 2000 kcal/day

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11
Q

Advantages of peripheral parenteral nutrition:

A

-Peripheral access is easily obtained by nonsurgical personnel
-Decreased risk of serious complications related to placement

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12
Q

Disadvantages of peripheral parenteral nutrition:

A

-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)

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13
Q

Peripheral parenteral nutrition is limited to less than or equal to _____ mOsm/L, which limits caloric density and protein content of peripheral parenteral nutrition

A

900

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14
Q

How to calculate the osmolarity for peripheral parenteral nutrition:

A

-Calculate the osmolarity for each component
-Total the osmolarity for all components
-Divide by the volume of the parenteral nutrition solution in liters

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15
Q

How to calculate the osmolarity for peripheral parenteral nutrition:

A

-Calculate the osmolarity for each component
-Total the osmolarity for all components
-Divide by the volume of the parenteral nutrition solution in liters

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16
Q

How can we determine the best route for parenteral nutrition?

A

-Anticipated duration of therapy
-Patient’s nutrient requirements
-Osmolarity of the parenteral nutrition solution
-Condition of the patient’s veins

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17
Q

What are two examples of peripheral vascular access devices?

A

-Peripheral catheters
-Midline catheters

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18
Q

With peripheral catheters, the catheter is placed in a peripheral vein using standard venipuncture methods at ____ to provide peripheral parenteral nutrition

A

Bedside

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19
Q

A midline catheter is inserted in veins above the ____ ____ into the basilic or cephalic vein and is extended up for 3-8 inches

A

Antecubital fossa

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20
Q

The tip of a midline catheter is in the ___ ___

A

Upper arm

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21
Q

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

A

Phlebitis

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22
Q

A midline catheter can only be used safely for up to ___-___ weeks

A

2-4

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23
Q

Midline catheters only deliver _____ parenteral nutrition

A

Peripheral

24
Q

What are examples of central vascular access devices?

A

-Short-term central venous catheters
-Peripherally inserted central catheter (PICC line)
-Tunneled catheters

25
Q

Short-term central venous catheters are used for ___-___ days

A

7-14

26
Q

Short-term central venous catheters are inserted at the patient’s bedside by an MD or specially trained RN, so it does not require _____

A

Surgery

27
Q

An example of a type of short-term central venous catheter is a ____

A

Hohn

28
Q

Short-term central venous catheters can be single or multi-____ catheters

A

Lumen

29
Q

Multi-lumen catheters are used to provide access for ____, ____, and ____ without interrupting or interfering with TPN

A

Medication, blood, and fluids

30
Q

Multi-lumen catheters also increase the risk for catheter-related ____

A

Infection

31
Q

Advantages of short-term central venous catheters:

A

-Does not require surgery for placement
-Easily removed

32
Q

Disadvantages of short-term central venous catheters:

A

-Risk of catheter displacement
-Difficult self-care for patient
-High-risk catheter-related infection and sepsis

33
Q

Peripherally inserted central catheters (PICC lines) have a peripheral entry site and use a guide wire used to guide the central line into the _____ _____ ____ _____

A

Distal superior vena cava

34
Q

Peripherally inserted central catheters (PICC lines) can be used for either ____ or ____ term central access (several weeks to months)

A

Short or moderate

35
Q

Peripherally inserted central catheters provide _____ only

A

TPN

36
Q

Advantages of peripherally inserted central catheters (PICC lines):

A

-Lower risk of placement complications
-Does not require surgery

37
Q

Disadvantages of peripherally inserted central catheters:

A

-Difficult self care (antecubital placement)

38
Q

A tunneled catheter is ____ placed and tunneled subcutaneously away from the insertion site

A

Surgically

39
Q

Tunneled catheters are used for ____-term access

A

Long

40
Q

Examples of types of tunneled catheters:

A

-Hickman
-Braviac
-Groshong

41
Q

Advantages of tunneled catheters:

A

-More secure
-Long-term use
-Easier self-care
-Decreased risk of infection (compared to non-tunneled)

42
Q

Disadvantages of tunneled catheters:

A

-Requires surgical placement and removal

43
Q

____ infusion of parenteral nutrition is running at the same rate non-stop for 24 hours

A

Continuous

44
Q

Continuous administration is the most ____ type of administration

A

Common

45
Q

Continuous administration is appropriate for:

A

-New PN orders
-Critically ill patients

46
Q

Cyclic infusion of parenteral nutrition less than 24 hours, usually ___-___ hours/day

A

8-12

47
Q

When would cyclic infusion be used?

A

-Home TPN
-Transitioning to oral diet

48
Q

Cyclic infusion is given at a higher rate, so people may have difficulty with ____ ____

A

Glucose control

49
Q

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

A

Separate

50
Q

The lipids are “piggybacked” into the ___ ___ that contains the amino acids and dextrose solution

A

IV line

51
Q

IV lipids provide a good growth medium for ____

A

Pathogens

52
Q

The CDC recommends that the maximum lipid hang time is ____ hours in order to decrease the risk of infection

A

12

53
Q

Advantages of 2-in-1 formulation with piggyback lipid infusion:

A

-Dextrose/amino acids solution is clear so we can see precipitates
-Can discontinue lipid without wasting entire bag of parenteral nutrition

54
Q

Disadvantages of 2-in-1 formulation with piggyback lipid infusion:

A

-Increased infection risk due to multiple manipulations at y-connection
-More nursing time and equipment

55
Q

3-in-1 or total nutrient admixture is when the ____, ____, and ____ are in one bag for IV administration

A

Carbohydrates, protein, and lipid

56
Q

Advantages of total nutrient admixture:

A

-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

57
Q

Disadvantages of total nutrient admixture:

A

-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

Advanced Medical Nutrition Therapy II (19 decks)

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