Section 7 - Parenterals 3 Flashcards
What is used for peritoneal dialysis?
Large bore catheter is placed into abdominal cavity through a “tunnel” and catheter usually has 2 Dacron cuffs to seal tunnel from microorganisms and leaks
What are the stages of peritoneal dialysis?
Hookup, infusion, diffusion (fresh), diffusion (waste), and drainage
What is used for continuous ambulatory peritoneal dialysis (CAPD)?
Soft catheters w/ 1 mm perforations and slots to allow fluid placement and removal
What are some complications that can arise from catheter placement?
- Bladder or bowel perforation
- Hemorrhage
- Hydrothorax
- Peritonitis
- Tunnel infection
How long does fluid remain in place during peritoneal dialysis?
4-6 hours (dwell time), based on patients needs
What is the usual daily fluid use for peritoneal dialysis?
About 8 L, based on patients needs
What is contained in fluid solutions for peritoneal dialysis?
Sodium, magnesium, calcium, and lactate in about the same concentrations found in blood
What effect does dextrose in fluid solutions have for peritoneal dialysis?
Determines the amount of water that will be removed from the patient
What are the available concentrations of dextrose for fluid solutions for peritoneal dialysis?
0.5, 1.5, 2.5, and 4.25%
During peritoneal dialysis, fluid and waste exchange is controlled by ____
Peritoneal membrane
What is peritoneal dialysis not effective at?
Removing phosphate, so antacid tablets are used as phosphate binders
What is the most common complication of peritoneal dialysis?
Infection; first is gram positive from staphylococcus on skin, then gram negative, third is candida which is very hard to treat
Who are candidates for parenteral nutrition?
- Severely malnourished
- Those w/ a dysfunctional GI tract for more than 5-7 days
- Post-surgical complications, severe trauma or burns, inflammatory bowel disease, chemotherapy, short-gut syndrome
- Pre-term infants
What are the normal energy needs for adults?
30-50 cal/kg/day
How can total energy requirement be estimated?
Resting energy expenditure (found from Harris-Benedict equation) * activity (1.1-1.3) * injury factors (1-2)
What can excess calories from carbs cause?
Liver damage and high production of CO2
What will occur if more than 5 mg/kg/minute of dextrose is given?
Hyperglycemia w/ high volume of diuresis
Are parenteral nutrition solutions hypo, iso, or hypertonic and what do they typically contain?
- Hypertonic
- As much as 25% and 5% amino acids, so administration through a suitably large vein is required
What are the fluid requirements for adults and for neonates?
- Adults = 50 mL/kg/day
- Neonates = 100-150 mL/kg/day
How is nitrogen provided through parenteral nutrition?
As a mixture of amino acids
What are the typical requirements of nitrogen?
0.16-0.32 g/kg/day
How much protein provides 1 g of nitrogen?
6.25 g of protein
How can nitrogen output be estimated?
Urinary urea nitrogen (accounts for about 85% of total nitrogen output)
What type of nitrogen balance is desired in most cases?
Slightly positive, so higher intake than output
What are the usual requirements of sodium?
1-2 mmol/kg/day
What are the usual requirements of potassium?
1.5 mmol/kg/day
What are the usual requirements of calcium?
0.15 mmol/kg/day
What are the usual requirements of magnesium?
0.15 mmol/kg/day
What are the usual requirements of phosphorus?
0.2 mmol/kg/day
What should be expected w/ respect to potassium and phosphorus when anabolic state is reached?
Temporary drop in serum levels b/c both are intracellular electrolytes
What are some possible complications w/ a catheter?
Thrombosis, occlusion, phlebitis
What are some metabolic complications w/ parenteral nutrition?
- Electrolyte imbalance
- Fluid imbalance
- Acidosis, alkalosis
- Hypo and hyperglycemia
- Liver abnormalities
