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Advanced MNT 2 > Parenteral Nutrition Part 2 > Flashcards

Parenteral Nutrition Part 2 Flashcards

1
Q

What does PPN mean

A

peripheral parenteral nutrition

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2
Q

what are the peripheral veins used for PPN?

also why?

A

median cubital
cephalic
basilic

smaller veins with lower blood flow

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3
Q

indications for PPN

A

short term use of ≤2 weeks
patient requires <2000 kcal/day

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4
Q

what are advantages of PPN

A

peripheral access is easily obtained by nonsurgical persons

decreased risk of serious complications related to placement

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5
Q

disadvantages of PPN

A

difficult to maintain for >3-4 days and may need to change site frequently

sensitivity to peripheral veins to hyperosmolar solutions

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6
Q

sensitivity of peripheral veins to hyperosmolar solutions results in increased risk of ________

PPN needs to be limited to _______ which limits ______&_______

A

phlebitis

≤900 mOsm/L
caloric density and protein content

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7
Q

How do you calculate the osmolarity of PPN ?

A

Calculate the Osm for each component
total Osm for all components

then divide by the volume of the PN solution in liters

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8
Q

Dextrose: 1 g = ___ mOsm
Amino acids: 1 g = ___ mOsm

Na: 1 mEq = ___ mOsm
K+: 1 mEq = ___ mOsm
Ca: 1 mEq = ____ mOsm
Mg: 1 mEq = ___ mOsm

A

5
10

2
2
1.4
1

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9
Q

CALCULATE OSMOLARITY

PPN order: 2.2 L of 264 g dextrose, 88 g AA, 55 g lipid, 75 mEq Na, 80 mEq K+, 8 mEq Mg, 10 mEq Ca

A

D=> 264 x 5= 1320 mOsm
AA=> 88 x 10 = 880 mOsm
Na=> 75 x 2 = 150 mOsm
K+=> 80 x 2 = 160 mOsm
Mg=> 8 x 1 = 8 mOsm
Ca=> 10 x 1.4 = 14 mOsm
Total = 2532 mOsm daily
Osmolarity = 2532/2.2L = 1151 mOsm/L

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10
Q

Total Parenteral nutrition is also called

A

central parenteral nutrition

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11
Q

TPN is administered through a ________ vein through a _______ site

A

central vein
venipuncture sites

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12
Q

for TPN what are the common venipuncture sites ?

tip placement into the __________

A

Subclavian (most common)
internal and external jugular veins

distal superior vena cava

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13
Q

TPN is used for patients who require PN for __________

A

long-term use >7-14 days

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14
Q

Advantages of TPN

A

central veins can accommodate the hyperosmolar solutions

central access is easier to maintain compared to PPN

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15
Q

Disadvantages of TPN

A

more serious complications than PPN

catheter must be inserted by specially trained personnel

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16
Q

how do u determine the route for PN?

A

anticipated duration of therapy***
patients nutrient requirements
osmolarity of the PN solution
condition of the patients veins

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17
Q

______________ are placed in a peripheral vein using standard venipuncture methods at bedside

Provide PPN

A

Peripheral Catheters

18
Q

Midline Catheters are inserted in veins located ___________________ such as ______ or ______ vein and extended up for ______ so that catheter tip is in _____

A

in veins above the antecubital fossa
basilic
cephalic
3-8 inches
upper arm

19
Q

Midline Catheters can be used safely for up to ______ and administer _____

Advantages of these midline catheters ?

A

2-4 weeks
PPN

Larger vein=>less phlebitis=>last longer

20
Q

Short-term Central Venous Catheters

Used for ______
Inserted at patient’s bedside by a MD or specially trained RN
Example: _____
___________ catheters

A

7-14 days
Hohn
Single or multi-lumen

21
Q

Short-term CVC Multi-lumen catheters

used to provide access for _______, _______, and _______ without interrupting/interfering with TPN

Increases risk for _____________

A

medications
blood products
fluids without

catheter-related infection

22
Q

Advantages of short term CVC

A

does not require surgery for placement
easily removed

23
Q

disadvantages of short term CVC

A

risk of catheter displacement
difficult self-care for patient
high risk for catheter-related infection & sepsis

24
Q

PICC lines are _________

Peripheral entry site, _______ used to guide central line into the _______

Can be used for __________ term TPN

A

Peripherally Inserted Central Catheters
guide wire
distal SVC

either short or moderate
(several weeks to months)

25
Q

PICC Lines advantages

A

Lower risk of placement complications
Does not require surgery

26
Q

PICC Lines Disadvantages

A

Difficult self care (antecubital placement)

27
Q

Tunneled Catheters are …

_________ placed and ___________
____________ access
Example: _________

A

surgically
tunneled away from insertion site

Long-term
Hickman

28
Q

Tunneled Catheters Advantages

A

More secure

Long-term use

Easier self-care

Decreased risk of infection (compared to non-tunneled)

29
Q

Tunneled Catheters Disadvantages

A

Requires surgical placement & removal

30
Q

administration methods for PN

A

continuos
cyclic

31
Q

Continuous Infusion
- Running at the same rate continuously for 24 hrs/day

Appropriate for:
_________ and _______

A

new PN orders
critically ill patients

32
Q

Most common type of administration

A

continuous

33
Q

Cyclic Infusion of a PN solution <24 hrs/d (usually ____ hrs/d)

Uses:
_________
________
________

A

8-12

home TPN

transitioning to oral diet

Given at a higher rate (difficulty with glucose control)

34
Q

compounding methods for PN

A

2 in 1 with piggyback lipid infusion
3 in 1 or total nutrient admixture (TNA)

35
Q

2-in-1 Formulation with Piggyback Lipid Infusion

Lipid emulsion is provided in a separate bag and has its own _________

The lipids are “piggybacked” into the IV line containing the amino acids & dextrose solution

Note: ILE provides __________
CDC=> maximum lipid hang time of ____ hrs to decrease risk of infection

A

rate of infusion

a good growth medium for pathogens
12

36
Q

2-in-1 Formulation with Piggyback Lipid Infusion Advantages

A

dextrose/aa solution is clear so can see precipitates

can discontinue lipid without wasting entire bag of PN

37
Q

2-in-1 Formulation with Piggyback Lipid Infusion Disadvantages

A

increased infection risk due multiple

manipulations at y-connector

more nursing time & equipment

38
Q

3-in-1 or Total Nutrient Admixture (TNA) is the combination of _____________ in one bag for intravenous administration

A

CHO, protein, and lipid

39
Q

3-in-1 or Total Nutrient Admixture (TNA) Advantages

A

Less nursing, pharmacy time and equipment

Fewer opportunities for extrinsic contamination

Convenience=>Home PN

Continuous 24-hour lipid infusion may enhance lipid oxidation and clearance

TNA is a poor growth medium for pathogens=> hyperosmolar, acidic

40
Q

3-in-1 or Total Nutrient Admixture (TNA) Disadvantages

A

Potentially unstable=> disruption of lipid emulsion

Impaired visual inspection for foreign particles or precipitates

Changes in TNA orders may result in wasting
Filter used with TNA does not remove all particulate matter

Iron and certain medications are incompatible with the lipid portion of the admixture

41
Q
A

Advanced MNT 2 (17 decks)

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