Unit 4 Parenteral Nutrition Services

Question 1

What is parenteral nutrition

Answer 1

Complex admixture of standard solutions containing nutrients

• there are more than 40 different components like macronutrients ( carbohydrates, lipids and amino acids ) and micronutrient ( electrolytes, trace minerals, vitamins )
• the nutrients are mixed into a bag and infused simultaneously into the blood circulation through peripheral or central vein

Question 2

Risk of aseptic preparathesis statement

Answer 2

• wrong formulation or preparation error
• contamination

Question 3

Key infection control components to consider when performing invasive procedure

Answer 3

• environmental control
• hand hygiene
• PPE selection
• aseptic field management
• non - touch technique
• sequencing

Question 4

Advantages of parenteral nutrition

Answer 4

• provides nutrients when less than 2 to 3 feet of small intestine remains
• allows nutrition support when GI intolerance prevents oral or enteral support

Question 5

Indications of total parenteral nutrition

Answer 5

• GI non functioning
• GI fistula
• acute pancreatitis
• short bowel syndrome
• malnutrition less than 10 % to 15 % weight loss

Question 6

Contraindications

Answer 6

• GI tract work
• terminally ill
• only needed briefly

Question 7

Parenteral components

Answer 7

Carbohydrate
- glucose or dextrose monohydrate 3.4 kcal/ g
Amino acids
- 3, 3.5, 5, 7, 8.5, 10 % solution
Fats
- 10 % emulsion = 1.1 kcal/ ml
20 % emulsion = 2 kcal/ ml

Question 8

Calculation of osmolarity of parenteral nutrition solution

Answer 8

1. W g of dextrose × 5 = X mOsm/ L
2. Y of protein × 10 = Z mOsm/ L
3. Fat is isotonic. Doesn’t contribute to osmolarity
4. Total osmolarity = X + Z = answered

Question 9

Compounding methods

Answer 9

• Total nutrient admixture of amino acids, glucose and additives
• 3 in 1 solution of lipid, amino acids, glucose and additives

Question 10

Administration

Answer 10

• Start slowly ( 1L 1st day, 2L 2nd day )
• stop slowly by reduce half every 1 to 2 hrs or switch to dextrose IV
• Cyclic give 12 to 18 hrs per day

Question 11

Document in chart

Answer 11

• type of feeding formula and tube
• rate and water flush
• intake energy and protein
• tolerance, complications and corrective actions
• patient education

Question 12

Standard Operating Procedure of parenteral nutrition

Answer 12

Personal responsibility
- new personnel must be trained in all necessary areas according to theory organization
- train of new personnel documented
- provisionally registered pharmacist and trainee dispenser shall be trained by pharmacist

Training and continued education
- training for all personnel shall be provided on continuous basis and will be recorded