TPN Flashcards

(46 cards)

1
Q

Protein kcal

A

4kcal/g

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2
Q

Protein mOsm

A

100 mOsm/%

%AA * 100 = mOsm

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3
Q

Dextrose kcal

A

3.4 kcal/g

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4
Q

Dextrose mOsm

A

50 mOsm/%
%D * 50 = mOsm

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5
Q

Dextrose peripheral % limit

A

10-12.5%

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6
Q

Lipid max infusion rate - adult

A

0.11 g/kg/h

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7
Q

Lipid max infusion rate - peds

A

0.15 g/kg/h

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8
Q

Intralipid and SMOF conc

A

2 kcal/mL

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9
Q

Omegaven conc

A

1.1 kcal/mL

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10
Q

Glucose infusion rate limit

A

4-5 mg/kg/min

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11
Q

Neonate fluid goal

A

start 60-80 ml/kg/d
titrate to 120-150 ml/kg/d

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12
Q

Neonate energy goal

A

80-120kcal/kg/day

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13
Q

Ped fluid goal

A

4:2:1 kg based ml/hg/hr

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14
Q

When to start TPN in adults - stable

A

Wait 7 days

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15
Q

When to start TPN in adults - nutritionally at risk

A

within 3-5 days

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16
Q

When to start TPN in adults with mod-severe malnutrition and EN not feasible

A

start ASAP
already has signs of malnutrition

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17
Q

When to start TPN in peds with self limiting illness

A

delay up to 7 days

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18
Q

When to start TPN in peds - stable

A

within 4-5 days

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19
Q

When to start TPN in infants- stable

A

within 1-3 days

20
Q

When to start TPN in VLBW neonates?

A

asap after birth

21
Q

When to start TPN in preterm or critically ill neonates?

A

when feasibly possible

22
Q

Neonate definition

A

first month of life

23
Q

Infant definition

A

first year of life (1month — <12 months)

24
Q

Child definition

A

1 to 10 years

25
Adolescent definition
11 to 17 years
26
Checking for allergies when using lipids
Check for egg (all) neonates usually haven't developed allergy yer
27
Nutritionally at risk
Weight loss >10lbs or 10% in 6 months or 5% in 1 month BMI <18.5 Altered diet or schedule
28
Evaluating appropriateness of TPN order
Evaluate daily fluid goals and energy requirements Calculate macronutrients Calculate electrolyte doses – consider special circumstances Select proper anion balance Perform safety checks - Max lipid rate: > adult 0.11 g/kg/hr > ped 0.15 g/kg/hr Glucose infusion rate Estimate osmolarity (%AA + %dextrose) >900 → central <900 → peripheral If TNA (3 in 1), ensure appropriate % composition for stability 4:10:2 for Amino acids, Dextrose, Lipids If 2 in 1 - no need to assess stability
29
Factors that increase Ca/Phos precipitation
More prone to PPT if: - high dose - high pH (basic) - high temp - long time - Ca chloride form (Ca gluconate preferred)
30
Monitoring lipids
IFALD Hypertriglyceridemia: 200400 Lipid deficiency
31
IFALD
overworked liver LFT Bilirubin
32
hypertriglyceridemia
Peds TG>200 mg/dL Adult TG>400 mg/dL
33
EFAD
Essential Fatty Acid deficiency 1. pt using lipid minimization strategy 2. malnourished kids
34
How to adjust caloric needs in obese patients
Calories will be lower - and based on IBW
35
Metabolic complications of TPN
BG, electrolyte changes High TG Liver function abnormalities - ACUTE AST/ALT elevation - Chronic ALP/bili (>2 wks)
36
Mechanical complications of TPN
Pneumothorax Catheter occlusion Thrombus Phlebitis -- TPN extravasation
37
Infectious complications of TPN
Central line infection Bacteremia Sepsis
38
Indications for TPN
poor absorption motility issues "bowel rest" Can't use enteral nutrition
39
Is TNA ok to use if it creams?
Yes, creaming is safe -- agitate to reverse
40
if TNA ok to use if it cracks?
No, cracking is irreversible separation, not safe to use
41
What is the min composition for stability in a TNA?
4% amino acids 10% dextrose 2% lipids
42
What is the benefit of cycled TPN?
gives liver time to rest minimizes risk of IFALD
43
Liver failure/disease special TPN
prefer BCAA >> AAA
44
Diabetes special TPN
High fat, low carb
45
COPD/pulmonary special TPN
High fat, low carbs (CO2 loading)
46
Trauma/burn special TPN
High protein, High energy