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PHA223 > Total parenteral nutrition in practice > Flashcards

Total parenteral nutrition in practice Flashcards

1
Q

What is enteral nutrition?

A

nutrition delivered into the gut by a tube when nutrition can’t be taken normally by the mouth but the gut is working

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2
Q

reasons for enteral nutrition

A
  • stroke/neurological conditions where swallowing impaired
  • after operation on face/neck/throat/gullet/stomach
  • blockages of guller/stomach
  • after radiotherapy to gullet/stomach
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3
Q

What is used first for enteral nutrition?

A

feeding tubes placed through the nostril, down oesophagus (gullet) and lie in the stomach or small bowel (jejunum - NJ tubes)

-> nasogastric tube

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4
Q

What is used if patient’s ability to eat won’t recover quickly/at all?

A

feeding tube placed through abdominal wall directly into stomach

-> gastrostomy - PEG

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5
Q

What route is PN given?

A

IV

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6
Q

Composition of PN solution

A

carbohydrates 60-70%

fat 30-40%

protein 1g or 30-40kcal from non-protein sources

electrolytes, minerals, vitamins, trace elements

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7
Q

What med classification is PN?

A

POM

-> needs to be on Rx

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8
Q

indications for PN

A
  • 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
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9
Q

What is the nutritional Rx for people NOT severly ill/injured/risk of feeding syndrome?

A
  • 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
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10
Q

How to start PN in an adult?

A
  • 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
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11
Q

When is PN indicated for children?

A
  • prematrurity
  • GIT abnormalities
  • low birth weight infants
  • major surgery
  • IBD
  • respiratory disorders (cystic fibrosis)
  • sepsis
  • burns (dehydration)
  • major traums
  • mucositis and malabsorption (chemotherapy)
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12
Q

What can energy loss be from in children?

A

ostomies
malabsorption
diarrhiea
infection

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13
Q

energy requirements for children

A

pre-term - 110-120kcal/kg/day

0-1 yrs - 90-100 kcal/kg/day

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14
Q

What formula calculates fluid requirements for children?

A

Holliday-Segar formula

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15
Q

What fluid requirements are needed for children? (Holliday-Segar formula)

A
  • 100 ml/kg/day for 1st 10kg of weight
  • 50 ml/kg/day for next 10kg
  • 20 ml/kg/day for weight over 20kg
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16
Q

What is the max fluid that male/female children need?

A

over 24hrs

  • males no more than 2500ml
  • females no more than 2000ml
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17
Q

What vol of fluid does 16kg child need in 24hrs?

A

10 x 100
6 x 50
= 1300ml

18
Q

What rate per hour needed for 1300ml for 16kg child?

A

1300 / 24
= 54.17

-> 54 or 55 ml/hr

19
Q

How much fluid for 125kg child over 24hrs?

A

10 x 100
10x x 50
105 x 20
= 3600ml

-> males 2500ml, females 200ml, so might not need this much

20
Q

How is PN administered?

A

peripheral IV catheter - cannula in arm

central IV catheter - central line into heart

21
Q

max glucose conc and osmolarity for peripharal PN

A

max glucose conc of 10%

max osmolarity 1210 mosmol/kg

22
Q

max glucose conc for central PN

A

can give high glucose concs

-> usually below 25% (18%)

23
Q

When should PN be stopped?

A

when patient is established on oral/enteral support

24
Q

2 types of monitoring for PN

A

physical

metabolic complications

25
Q

physical monitoring for PN

A
  • body weight
  • length/height
  • head circumference

-> plotted on growth charts, same scales used, undressed

26
Q

metabolic complications monitoring

A

short term

  • re-feeding syndrome
  • hyperglycaemia
  • hypoglycaemia
  • hypertriglyceridemia
  • mineral/electrolyte imbalances

-> close monitoring in first week

27
Q

What is re-feeding syndrome?

A

reduction in basal metabolic rate during times of semi-starvation

rapid change in metabolic status when feeding re-introduced

-> can have life-threatening complications

28
Q

How to re-introduce calories?

A

slowly

  • 50% day 1
  • 75% day 2
  • 100% day 3

-> may need to be slower, daily bloods essential

29
Q

What mineral has an increased requirement when re-introducing calories?

A

phosphate

  • when body switching back to carb metabolism
  • P depeltion in starvation
30
Q

What patients are at risk of re-feeding?

A

1 of these:

  • BMI < 16
  • unintentional weight loss > 15% in last 3-6mths
  • little/no nutritional intake for > 10 days
  • low potassium/phosphate/magnesium levels before feeding

2+ of these risk factors:

  • BMI < 18.5
  • unintentional weight loss >10% 3-6mths
  • no intake > 5 days
  • Hx alcohol abuse/drugs (insulin, chemo, antacids, diuretics)
31
Q

What nutrition is given for those at risk of re-feeding?

A
  • start at max 10 kcal/kg/day
  • inc slowly by 4-7 days
  • 5 kcal/kg/day in extreme cases
  • respore cirsulatory vol/monitor fluid balance
32
Q

What additional things given for risk of re-feeding before PN and for first 10 days?

A
  • oral thiamine 200-300 mg daily
  • Vit B co strong 1 or 2 tabs TDS (or full dose IV Vit B)
  • balanced multivitamin/trace element supplement OD
33
Q

What supplements need to be given for oral/enteral/IV?

A

potassium
phosphate
magnesium

34
Q

What needs to be monitored?

A
  • lipids and triglycerides
  • trace elements and vitamin deficiencies
  • hepatic dysfunction
35
Q

Why monitor lipids and triglycerides?

A

levels needed to determine patient’s oxidative capacity for lipid metabolism

36
Q

Why monitor tracelements and vitamin deficiencies?

A

deficiencies can occur in patients on LT PN

don’t need routiene monitoring unless pt fed > 1 mth

not an issue when pt on established PN feeding

37
Q

Why monitor hepatic dysfunction?

A
  • allow early detection of liver adverse effects

- cholestasis is a complication

38
Q

complications of PN

A

infection - catheter related spesis, systemic infection

metabolic - glucose intolerance, electrolyte disturbances, acidosis, cholestasis

administration - line access, compatibility information

39
Q

compatibility with PN

A

don’t mix PN/lipid with any other meds

-> nothing down the same lumen

40
Q

Why is enteral nutrition preferred over parenteral nutrition? (working gut)

A
  • more physiological (working gut)
  • simpler (no IV)
  • cheaper
  • less complicated

-> might need both

PHA223 (43 decks)

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