TPN concepts Flashcards
enteral nutrition
GI tract
- oral (swallow, tube feeding)
- if unable to swallow, tube into stomach or small intestine
parenteral nutrition
- intravenous (large veins, eg, subclavian vein)
- total parenteral nutrition (TPN)
TPN is…
total body nutrition, duh
- dextrose
- lipids
- amino acids
- electrolytes
- vitamins/minerals
- trace elements
- medications
total parenteral nutrition: how long & what is it
- short or long term
- significant nutritional support
peripheral parenteral nutrition: how long & what is it
- short term use only
- partial nutritional support
MUST have before TPNing it up
- central venous catheter
- dedicated infusion port
- radiographic confirmation of placement
TPN risks
- DVT
- infection
- cirrhosis
- pancreatitis, cholesystitis
- GI atrophy
- translocation of bacteria
TPN initiation (how & why)
gradual, directed by TPN team
- prevent hyperglycemia!
TPN discontinuation (how & why)
gradual, prevent hypoglycemia
- sudden? initiate dextrose infusion!!
enteral feeding routes
- nasogastric tube
long-term:
- gastronomy tube
- jejunostomy tube, nasoduodenal, nasojejunal
bolus feeding
250 - 400 mL solution rapidly administered through syringe or funnel into tube
- 4 to 6 times daily
- 10 minutes each feeding
- may not be tolerated (n/v/d, aspiration, abdominal cramp)
- usually for ambulatory
intermittent enteral
administered every 3 to 6 hours over 30 to 60 minutes by gravity drip or pump infusion
- 300 to 400 mL solution given
- feeding bag used
continuous feedings
- for critically ill
- for feedings into small intestine
- infusion pump (Kangaroo); slow rate over 24 hours
- 50 to 125 mL infused per hour
cyclic method
continuous feeding infused over 8 to 16 hours daily
- for patients who are restless, greater risk of aspiration
- nighttime schedule = freedom for ambulatory patients
major complication of enteral nutrition
aspiration pneumonitis
- may occur if patient fed while lying down or unconscious
- high fowler’s, check for gastric residual by aspirating
