Ch. 21: Parenteral Nutrition

1
Ch. 21 Parenteral Nutrition

• Parenteral Nutrition Delivery of nutrient
  solutions directly into a vein, bypassing the
  intestinal tract
• IV Nutrition can be tailored to individual needs
• Can provide water, amino acids, carbohydrate, fat
  and micronutrients

2
Rationale for Determining Feeding Route
3
Parenteral Nutrition

• Advantages
• Can provide total nutritional support for longer
  period of time
• Disadvantages of Parenteral Nutrition
• Costly
• Complications
• Sepsis
• Liver
• Kidneys
• Bone disorders
• Deficiencies

4
Parenteral Solutions, cntd.

• Intravenous nutrients
• Amino acids essential and nonessential
  (branch-chained and aromatic)
• Carbohydrate dextrose 3.4 kcal/gm
• Lipids LCT or MCT, EFAs
• Micronutrients prevention of deficiencies

5
Types of Intravenous Formulataions

• Types Intravenous Solutions
• Simple
• simple IV solutions typically contain 5 percent
  dextrose and/or normal saline (Normal saline is a
  solution of sodium and chloride in water)
• other electrolytes or salts may be added
• Types Intravenous Solutions
• Complete
• complete nutrient solutions provide amino acids,
  dextrose, fatty acids, vitamins, minerals, and
  trace elements
• can be delivered into peripheral veins (the
  small-diameter veins that carry blood from the
  arms and legs) or central veins (the
  large-diameter veins located close to the heart)

6

• Simple Intravenous Infusions
• used in medical conditions that disrupt acid base
  balance or fluid and electrolyte balance
• are delivered via a IV catheter through a
  peripheral forearm vein
• An IV catheter is a thin tube inserted into a
  peripheral or central vein. Additional tubing
  connects the IV solution to the catheter

7
Peripheral vs Total Parenteral Nutrition

• Compare the composition and uses of PPN andTPN
• Peripheral Parenteral
• Nutrition (PPN)
• Isotonic formula
• Contains all essential nutrients
• Requires renal functioning
• Short-term 7-14 days
• Additional support for enteral feedings
• Used when TPN not possible

8
PPN and TPN, cntd.

• Total Parenteral Nutrition (TPN) Central Vein
• IV catheter in large central vein
• Highly concentrated solutions
• Long-term use
• High nutritional needs
• Client is severely malnourished
• Higher risk of infection

9
(No Transcript)
10
IV Nutrition

• What risks are associated with IV Nutrition?
• IV Nutrition Risks
• TPN requires surgical placement
• Peripheral veinsinflammation infection
• TPN Disease causing microorganisms introduced
• Complications on p. 526

11
IV Nutrition

• Proper way to administer PPN and TPN solutions
• PPN Peripheral veins can collapse if
  concentration too high
• TPN Feeding started slowly because of high
  glucose content and high osmolality of solutions
• Infusion pump required
• Hypoglycemia hyperglycemia risks
• Electrolytes monitored vigilantly

12
Transition from Parenteral to Enteral Nutrition

• Appropriate transition from parenteral to enteral
  nutrition
• Villi will shrink and lose ability to function as
  a result of nonuse
• Slow reintroduction of enteral nutrition
• Transitional Feedings
• TPN tapered off gradually
• PPN doesnt require tapering off

13
Transitioning, cntd.

• Rule of Thumb 1
• If clients cant eat enough food to meet at least
  50 of daily nutritional needs tube feedings
  should be considered.
• Rule of Thumb 2
• Parenteral nutrition can be discontinued when at
  least 70-75 of energy needs are being met by
  oral intake, tube feedings or both

14
Home Nutrition Support

• Identify the benefits of and the criteria used to
  select candidates for home nutrition support
• Medical considerations
• Rational, stable personality
• Learning techniques, handling complications
• Compliant with recommendations
• Adequate financial resources support

15
Practice Questions

• Types of formulas that contain complete proteins
  are called
• Intact
• Hydrolyzed
• Modular
• Blenderized

16

• Hydrolyzed formulas are given to clients who are
  able to digest and absorb nutrients without
  difficulty.
• True
• False

17

• The primary purpose of a simple IV solution is to
  support all of the following EXCEPT
• a. Help maintain fluid and electrolyte balance
• b. Help maintain adequate nutrient intake
• c. Help restore acid-base balance

18

• Ideally a person should reach a severely-depleted
  state before TPN by central vein is initiated.
• True
• False