Rd Flashcards
Facility codes
A= WRC B= Plains C = RGH D = PH
Typical TF flushes
60-120-150
LTC tube patency
25-30 ml QID
Normal body temp
37 C
Normal BMI young and older
19-25 or 23-30
Kcal needs LtC
60+ = 25-30
<60 = 30-35
Protein typical LTC wounds wasted
Acute care
1-1.2; 1.2; 1.5
1.2-1.5
Fluid needs LTC; acute
LTC: 1 ml/kg or 30-40 ml/kg
Acute: >65 = 25 ml/kg
55-65 = 30
25-55= 35
15-30=40
Refeeding kcal/kg
Refeeding TPN g dextrose
Reefeeding max GIR
10-20 kcal/kg
Or 15 kcal/ kg
<150-200 g dextrose
GIR < 2
Labs TPN,
TPN= 3 consecutive days then q Mon, Thurs. fine to keep same schedule after changing ppn to TPN.
Vit K day for TPN
Monday
How long peripheral vs central line TPN
Central if > 1-2 weeks
How long peripheral vs central line TPN
Central if > 1-2 weeks
Peripheral TPN time, dex %, max osmolarity, electrolyte maxes, protein %; meets needs, typical fluid volume?
< 2 weeks
< 7-10% dex
900 osmol/L
KCl < 40 mmol/litre
10 meq Mg max
10 Ca max
< 4% protein
No. Often reefeeding amount continues unless fluid can be increased
30-40 ml/kg
How much of fluid needs met w TPN
75-80%
Lipid products
Use SMOF unless fish allergy then intralipid
Maximum TPN compound Regina
9% aa and 25% dextrose
Less than what volume TPN unlikely to compound
< 1 litre
Cycling TPN
Change rate gradually
See new TPN, note rate change with new bag. Check BG one hour after stopping Tpn x 2-3 days
24-20 hours if decreased fluid tolerance of oral intake, increase GIR .5 likely ok. Too much change if high Refeeding risk or not eating po.
Hemolyzed sample
Falsely elevated K
TPN K
1 meq/kg unless
High none
Ppn max 40/L
Sodium TPN
1/kg
Refeeding use 20-40
77 meq/L = NS
2-3 numbers up or down not sig. enough to adjust TPN
Never above 2 even if sodium low (likely other factor ie: high ostomy output, vomiting, meds, diarrhea)
If seems expect to be on low end or slightly low. Don’t adjust TPN.
Don’t increase Na if Refeeding risk even if low.
Refeeding electrolytes
Need higher K, Mg, phos. Lower Na.
Electrolytes TPN
1-2 meq
1-2 meq
15-20
15-20
10-15
When to not add trace minerals
If ALP and bilirubin BOTH elevated: do not add TE. Flip to back. Add Zn and Cr. No Cu or Mang.
Thiamine to TPN
100 daily x 5 days if Refeeding risk
Folic acid TPN
Add except with lower GI CA Janelle
Or only if ETOH or inflammatory bowel disease (Michelle)
Vitamin k tPN
Always add unless taking Warfarin
Selenium TPN
Always add
When to minimize chloride
If elevated (Janelle)
If >~120 (Michelle)
TPN label
New TPN Nov 3
Vit K today and every Monday
Thiamine 100 meq (03 Nov-07Nov)
SMoF 168 ml/24 hours
If —————— low then 0 in TPN
K, phos (not hemolyzed)
When to worry re: TG on TPN
When 4-5
Stopping TPN/PPN
TPN run 1/2 rate 1-2 hours
PPN can just stop
SHA TPN protein product
Travasol
