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604 > TPN > Flashcards

TPN Flashcards

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
Q

Adolescent definition

A

11 to 17 years

26
Q

Checking for allergies when using lipids

A

Check for egg (all)
neonates usually haven’t developed allergy yer

27
Q

Nutritionally at risk

A

Weight loss >10lbs or 10% in 6 months
or 5% in 1 month
BMI <18.5
Altered diet or schedule

28
Q

Evaluating appropriateness of TPN order

A

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
Q

Factors that increase Ca/Phos precipitation

A

More prone to PPT if:
- high dose
- high pH (basic)
- high temp
- long time
- Ca chloride form (Ca gluconate preferred)

30
Q

Monitoring lipids

A

IFALD
Hypertriglyceridemia: 200400
Lipid deficiency

31
Q

IFALD

A

overworked liver
LFT
Bilirubin

32
Q

hypertriglyceridemia

A

Peds TG>200 mg/dL
Adult TG>400 mg/dL

33
Q

EFAD

A

Essential Fatty Acid deficiency
1. pt using lipid minimization strategy
2. malnourished kids

34
Q

How to adjust caloric needs in obese patients

A

Calories will be lower - and based on IBW

35
Q

Metabolic complications of TPN

A

BG, electrolyte changes
High TG
Liver function abnormalities
- ACUTE AST/ALT elevation
- Chronic ALP/bili (>2 wks)

36
Q

Mechanical complications of TPN

A

Pneumothorax
Catheter occlusion
Thrombus
Phlebitis – TPN extravasation

37
Q

Infectious complications of TPN

A

Central line infection
Bacteremia
Sepsis

38
Q

Indications for TPN

A

poor absorption
motility issues
“bowel rest”
Can’t use enteral nutrition

39
Q

Is TNA ok to use if it creams?

A

Yes, creaming is safe – agitate to reverse

40
Q

if TNA ok to use if it cracks?

A

No, cracking is irreversible separation, not safe to use

41
Q

What is the min composition for stability in a TNA?

A

4% amino acids
10% dextrose
2% lipids

42
Q

What is the benefit of cycled TPN?

A

gives liver time to rest
minimizes risk of IFALD

43
Q

Liver failure/disease special TPN

A

prefer BCAA&raquo_space; AAA

44
Q

Diabetes special TPN

A

High fat, low carb

45
Q

COPD/pulmonary special TPN

A

High fat, low carbs (CO2 loading)

46
Q

Trauma/burn special TPN

A

High protein, High energy

604 (18 decks)

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