Parenteral Nutrition Part 2 Flashcards
What does PPN mean
peripheral parenteral nutrition
what are the peripheral veins used for PPN?
also why?
median cubital
cephalic
basilic
smaller veins with lower blood flow
indications for PPN
short term use of ≤2 weeks
patient requires <2000 kcal/day
what are advantages of PPN
peripheral access is easily obtained by nonsurgical persons
decreased risk of serious complications related to placement
disadvantages of PPN
difficult to maintain for >3-4 days and may need to change site frequently
sensitivity to peripheral veins to hyperosmolar solutions
sensitivity of peripheral veins to hyperosmolar solutions results in increased risk of ________
PPN needs to be limited to _______ which limits ______&_______
phlebitis
≤900 mOsm/L
caloric density and protein content
How do you calculate the osmolarity of PPN ?
Calculate the Osm for each component
total Osm for all components
then divide by the volume of the PN solution in liters
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
5
10
2
2
1.4
1
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
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
Total Parenteral nutrition is also called
central parenteral nutrition
TPN is administered through a ________ vein through a _______ site
central vein
venipuncture sites
for TPN what are the common venipuncture sites ?
tip placement into the __________
Subclavian (most common)
internal and external jugular veins
distal superior vena cava
TPN is used for patients who require PN for __________
long-term use >7-14 days
Advantages of TPN
central veins can accommodate the hyperosmolar solutions
central access is easier to maintain compared to PPN
Disadvantages of TPN
more serious complications than PPN
catheter must be inserted by specially trained personnel
how do u determine the route for PN?
anticipated duration of therapy***
patients nutrient requirements
osmolarity of the PN solution
condition of the patients veins
______________ are placed in a peripheral vein using standard venipuncture methods at bedside
Provide PPN
Peripheral Catheters
Midline Catheters are inserted in veins located ___________________ such as ______ or ______ vein and extended up for ______ so that catheter tip is in _____
in veins above the antecubital fossa
basilic
cephalic
3-8 inches
upper arm
Midline Catheters can be used safely for up to ______ and administer _____
Advantages of these midline catheters ?
2-4 weeks
PPN
Larger vein=>less phlebitis=>last longer
Short-term Central Venous Catheters
Used for ______
Inserted at patient’s bedside by a MD or specially trained RN
Example: _____
___________ catheters
7-14 days
Hohn
Single or multi-lumen
Short-term CVC Multi-lumen catheters
used to provide access for _______, _______, and _______ without interrupting/interfering with TPN
Increases risk for _____________
medications
blood products
fluids without
catheter-related infection
Advantages of short term CVC
does not require surgery for placement
easily removed
disadvantages of short term CVC
risk of catheter displacement
difficult self-care for patient
high risk for catheter-related infection & sepsis
PICC lines are _________
Peripheral entry site, _______ used to guide central line into the _______
Can be used for __________ term TPN
Peripherally Inserted Central Catheters
guide wire
distal SVC
either short or moderate
(several weeks to months)
PICC Lines advantages
Lower risk of placement complications
Does not require surgery
PICC Lines Disadvantages
Difficult self care (antecubital placement)
Tunneled Catheters are …
_________ placed and ___________
____________ access
Example: _________
surgically
tunneled away from insertion site
Long-term
Hickman
Tunneled Catheters Advantages
More secure
Long-term use
Easier self-care
Decreased risk of infection (compared to non-tunneled)
Tunneled Catheters Disadvantages
Requires surgical placement & removal
administration methods for PN
continuos
cyclic
Continuous Infusion
- Running at the same rate continuously for 24 hrs/day
Appropriate for:
_________ and _______
new PN orders
critically ill patients
Most common type of administration
continuous
Cyclic Infusion of a PN solution <24 hrs/d (usually ____ hrs/d)
Uses:
_________
________
________
8-12
home TPN
transitioning to oral diet
Given at a higher rate (difficulty with glucose control)
compounding methods for PN
2 in 1 with piggyback lipid infusion
3 in 1 or total nutrient admixture (TNA)
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
rate of infusion
a good growth medium for pathogens
12
2-in-1 Formulation with Piggyback Lipid Infusion Advantages
dextrose/aa solution is clear so can see precipitates
can discontinue lipid without wasting entire bag of PN
2-in-1 Formulation with Piggyback Lipid Infusion Disadvantages
increased infection risk due multiple
manipulations at y-connector
more nursing time & equipment
3-in-1 or Total Nutrient Admixture (TNA) is the combination of _____________ in one bag for intravenous administration
CHO, protein, and lipid
3-in-1 or Total Nutrient Admixture (TNA) Advantages
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
3-in-1 or Total Nutrient Admixture (TNA) Disadvantages
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
