TPN Online Flashcards
in a tpn bag there are up to 12-15 constituents therefore chem stability and X are key
sterility
what are the two types of tpn bags
bespoke or off the shelf
off the shelf parenteral nutrition bags are pre made and pre formulated with various different ones for you to select give 2 examples
kabiven
triomel
what is meant by tpn
all macronutrient, micronutrient and fluid requirements are met by iv nutrient solution and none obtained from other sources
tpn is given iv and bypasses the
GIT
tpn is given centrally via a cvab what is this
central venous access device
where is the tip of the cvab located in the body
vena cava or right atrium of the heart
what is the benefit of giving tpn centrally
volume of blood flow, pn can be given with high osmolality without problems
some hospitals will give tpn peripherally, what is the drawback of this
restricts osmolality and calories you are bale to give
what is the risk of giving tpn peripherally via a cannula
damage to small veins and vessels of the hand/ arm
give some insertion related risks that are associated with cvabs
pneumothorax and haemorrhage
what are 4 risks of tpn delivery
septicaemia
hyperglycaemia
metabolic imbalances
fluid overload
where does mechanical digestion start which then forms a bolus
in the mouth by the teeth
the bolus goes down oesophagus into stomach which churns food, chemical digestion starts and turns the bolus into a liquid called
chyme
chyme passes through pylorus into
duodenum
when chyme enters duodenum, gallbladder is stimulated to release
bile
what does bile do to chyme
emulsify fats and break food into smaller particles
pancreas is stimulated to release enzymes to break food down further, chyme gradually moves through jejunum and
ileum
what happens to food in the jejunum and ileum
nutrients are extracted and absorbed
which structure reabsorbs water and waste products are passed out through the rectum and the anus
LI
why is feeding into gi tract/ enteral feeding always preferred
safe
cheap
physiologically normal
what is meant by intestinal failure
non functional
inaccessible or
perforated gi tract
how many different types of intestinal failure are there
3
outline type 1 intestinal failure
acute
short term
resolves over a few days
self limiting
outline type 2 intestinal failure
prolonged acute condition
metabolically unstable patients
pn required for weeks or months
outline type 3 intestinal failure
chronic condition
metabolically stable
require pn for months or years
is type 3 intestinal failure reversible, irreversible or can it be both
both
give some common indications for type 1 and type 2 IF which would prompt pn
anastomotic leak
fistula in gi tract
bowel rest
failed enteral feeding
what must you ask before you start tpn
can patient be fed enterally (always preferred)
if not why not
do benefits outweigh the risks
patients risk of malnutrition should be assessed using a screening tool, name one
MUST
what would you use for the slow introduction of oral fluids
water
what would you use as a guide to know that tpn can be withdrawn
monitor drain output and confirm healing
true or false, you do not need to determine the aim of pn from the outset
false
pn required for several months to allow either X or Y
reduction of inflamm then surgery to close fistula
reduction of inflamm and healing of fistula
what to consider abt px risk before tpn
risk of malnutrition
