Total parenteral nutrition in practice Flashcards
What is enteral nutrition?
nutrition delivered into the gut by a tube when nutrition can’t be taken normally by the mouth but the gut is working
reasons for enteral nutrition
- stroke/neurological conditions where swallowing impaired
- after operation on face/neck/throat/gullet/stomach
- blockages of guller/stomach
- after radiotherapy to gullet/stomach
What is used first for enteral nutrition?
feeding tubes placed through the nostril, down oesophagus (gullet) and lie in the stomach or small bowel (jejunum - NJ tubes)
-> nasogastric tube
What is used if patient’s ability to eat won’t recover quickly/at all?
feeding tube placed through abdominal wall directly into stomach
-> gastrostomy - PEG
What route is PN given?
IV
Composition of PN solution
carbohydrates 60-70%
fat 30-40%
protein 1g or 30-40kcal from non-protein sources
electrolytes, minerals, vitamins, trace elements
What med classification is PN?
POM
-> needs to be on Rx
indications for PN
- BMI < 18.5
- unintentional weight loss > 10% within 3-6mths
- BMI < 20 and unintentional weight loss > 5% within last 3-6mths
- eaten little/nothing for > 5 days and likely for next 5+
- poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from catabolism
- inadequate/unsafe oral/enteral nutritional intake
- non-functional/leaking GIT
What is the nutritional Rx for people NOT severly ill/injured/risk of feeding syndrome?
- 25-35 kcal/kg/day (total energy)
- 0.8-1.5g protein/kg/day
- 30-35 ml fluid/kg (allow for losses and other IV inputs)
- adequate electrolytes, minerals, micronutrients, fibre
How to start PN in an adult?
- start with no more than 50% of estimated target energy and protein need
- built up to meet needs over 24-48hrs
- full requirements of fluid, electrolytes, vits, from start
- eaten little/nothing past 5 days, introduce no more than 50% for first days
When is PN indicated for children?
- prematrurity
- GIT abnormalities
- low birth weight infants
- major surgery
- IBD
- respiratory disorders (cystic fibrosis)
- sepsis
- burns (dehydration)
- major traums
- mucositis and malabsorption (chemotherapy)
What can energy loss be from in children?
ostomies
malabsorption
diarrhiea
infection
energy requirements for children
pre-term - 110-120kcal/kg/day
0-1 yrs - 90-100 kcal/kg/day
What formula calculates fluid requirements for children?
Holliday-Segar formula
What fluid requirements are needed for children? (Holliday-Segar formula)
- 100 ml/kg/day for 1st 10kg of weight
- 50 ml/kg/day for next 10kg
- 20 ml/kg/day for weight over 20kg
What is the max fluid that male/female children need?
over 24hrs
- males no more than 2500ml
- females no more than 2000ml
What vol of fluid does 16kg child need in 24hrs?
10 x 100
6 x 50
= 1300ml
What rate per hour needed for 1300ml for 16kg child?
1300 / 24
= 54.17
-> 54 or 55 ml/hr
How much fluid for 125kg child over 24hrs?
10 x 100
10x x 50
105 x 20
= 3600ml
-> males 2500ml, females 200ml, so might not need this much
How is PN administered?
peripheral IV catheter - cannula in arm
central IV catheter - central line into heart
max glucose conc and osmolarity for peripharal PN
max glucose conc of 10%
max osmolarity 1210 mosmol/kg
max glucose conc for central PN
can give high glucose concs
-> usually below 25% (18%)
When should PN be stopped?
when patient is established on oral/enteral support
2 types of monitoring for PN
physical
metabolic complications
