TPN Flashcards
Classes of Intestinal Failure
I - Acute, short term, self limiting
II - Prolonged acute, metbolically unstable patients requiring IV supplementation long term
III - Chronic, metabolically stable patients requiring IV supplementation months/years
Causes of intestinal failure
- short bowel syndrome (75%)
- Intestinal fistula
- intestinal dysmotility
- obstruction
Features of intestinal failure
malnutrition/weight loss
dehydration
electrolyte deficiencies (Na depletion)
micronutrient deficiencies (vit D def)
Treatment
Antidiarrhoeal
1st line - loperamide start 4mg qds
30-60 mins before food
2nd line - codeine 30-60mg
Antisecretory (PPIs)
3rd line - discuss
octreotide, colestyramine
To avoid in intestinal failure?
oral
M/R and E/C
When to use parenteral?
When it is not possible to use enteral (e.g. NG, NJ, PEG, oral)
Deciding which administration to use enteral long/short term?
Functional GIT
ENTERAL
Short term - NG, NJ
Long term - PEG. PEJ
Assessment for PN
PMH, allergies, fluid balance - output (urine, vomiting, drains, diarrhoea, gastric aspirates)
Lab results
When fluid intake requirements are decreased?
renal impairment
cardiac failure
oedema
Types of bags administered centrally/ peripherally
All PN bags can go centrally
but only few bags can be administered peripherally
Complications with PN
Metabolic - fatty liver
Mechanic - catheter occlusion, thrombophlebitis
Microbiological - contamination, blood infection
Refeeding syndrome - reintroduction of nutrition after period of starvation. 10 cal/kg/day then increase. Consider IV Pabrinex
causes severe abnormalities of electrolytes, fluid balance and vitamins
What is home parenteral nutrition indicated for?
Type III intestinal failure
Reviewed by NST at clinic every 3 months
