TPN Flashcards
Protein kcal
4kcal/g
Protein mOsm
100 mOsm/%
%AA * 100 = mOsm
Dextrose kcal
3.4 kcal/g
Dextrose mOsm
50 mOsm/%
%D * 50 = mOsm
Dextrose peripheral % limit
10-12.5%
Lipid max infusion rate - adult
0.11 g/kg/h
Lipid max infusion rate - peds
0.15 g/kg/h
Intralipid and SMOF conc
2 kcal/mL
Omegaven conc
1.1 kcal/mL
Glucose infusion rate limit
4-5 mg/kg/min
Neonate fluid goal
start 60-80 ml/kg/d
titrate to 120-150 ml/kg/d
Neonate energy goal
80-120kcal/kg/day
Ped fluid goal
4:2:1 kg based ml/hg/hr
When to start TPN in adults - stable
Wait 7 days
When to start TPN in adults - nutritionally at risk
within 3-5 days
When to start TPN in adults with mod-severe malnutrition and EN not feasible
start ASAP
already has signs of malnutrition
When to start TPN in peds with self limiting illness
delay up to 7 days
When to start TPN in peds - stable
within 4-5 days
When to start TPN in infants- stable
within 1-3 days
When to start TPN in VLBW neonates?
asap after birth
When to start TPN in preterm or critically ill neonates?
when feasibly possible
Neonate definition
first month of life
Infant definition
first year of life (1month — <12 months)
Child definition
1 to 10 years
Adolescent definition
11 to 17 years
Checking for allergies when using lipids
Check for egg (all)
neonates usually haven’t developed allergy yer
Nutritionally at risk
Weight loss >10lbs or 10% in 6 months
or 5% in 1 month
BMI <18.5
Altered diet or schedule
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
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)
Monitoring lipids
IFALD
Hypertriglyceridemia: 200400
Lipid deficiency
IFALD
overworked liver
LFT
Bilirubin
hypertriglyceridemia
Peds TG>200 mg/dL
Adult TG>400 mg/dL
EFAD
Essential Fatty Acid deficiency
1. pt using lipid minimization strategy
2. malnourished kids
How to adjust caloric needs in obese patients
Calories will be lower - and based on IBW
Metabolic complications of TPN
BG, electrolyte changes
High TG
Liver function abnormalities
- ACUTE AST/ALT elevation
- Chronic ALP/bili (>2 wks)
Mechanical complications of TPN
Pneumothorax
Catheter occlusion
Thrombus
Phlebitis – TPN extravasation
Infectious complications of TPN
Central line infection
Bacteremia
Sepsis
Indications for TPN
poor absorption
motility issues
“bowel rest”
Can’t use enteral nutrition
Is TNA ok to use if it creams?
Yes, creaming is safe – agitate to reverse
if TNA ok to use if it cracks?
No, cracking is irreversible separation, not safe to use
What is the min composition for stability in a TNA?
4% amino acids
10% dextrose
2% lipids
What is the benefit of cycled TPN?
gives liver time to rest
minimizes risk of IFALD
Liver failure/disease special TPN
prefer BCAA»_space; AAA
Diabetes special TPN
High fat, low carb
COPD/pulmonary special TPN
High fat, low carbs (CO2 loading)
Trauma/burn special TPN
High protein, High energy
