Review of Test

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Review

• Review of Test Mid-term Points
• Chapter 21 -
• Products Standard/Hydrolyzed/Modular
• Initiation
  15-30 mL full strength w/u to goal rate 15-30 mL
  as tol q shift
• Delivery Intermittent/Bolus/Continuous
• Placement NG/PEG/PEJ

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Ch. 21 Parenteral Nutrition

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

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Rationale for Determining Feeding Route
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Parenteral Nutrition

• Advantages
• Can provide total nutritional support for longer
  period of time when gut is dysfunctional.
• Disadvantages of Parenteral Nutrition
• Costly
• Surgery Sedation
• Complications
• Sepsis
• Liver
• Kidneys
• Bone disorders
• Nutrient Deficiencies

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Intravenous Macro-Nutrients

• Amino acids essential and nonessential
• Essential nonessential
• Tailored for specific conditions
• 4.0 kcal /gm
• Carbohydrate
• Dextrose monohydrate
• 3.4 kcal/gm
• Insulin coverage in TPN
• Lipids
• LCT or MCT, Immunosuppressive in US
• 10 provide 1.1 kcal/mL
• 20 provide 2.0 kcal/mL

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Intravenous Micro-Nutrients

• Vitamins
• Minerals
• Electrolytes
• Trace Elements
• Deficiencies have serious often irreversible
  consequences

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Types of Intravenous Formulations

• Types Intravenous Solutions
• Simple
• NS IV Dextrose w/ Electrolytes
• Inadequate in kcal/pro
• Intermediate Procalamine/Aminosyn
• Complete
• complete nutrient solutions provide amino acids,
  dextrose, fatty acids, vitamins, minerals, and
  trace elements
• PPN - peripheral vein access
• TPN central vein access

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IV Therapy

• 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

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PPN vs. TPN

• Compare the composition and uses of PPN and TPN
• 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 or desired

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PPN vs.TPN, cntd.

• Total Parenteral Nutrition (TPN) Central Vein
• IV catheter in large central vein
• Concentrated solutions
• Long-term use
• High nutritional needs
• Client may be severely malnourished
• Higher risk of infection
• Risk of Re-feeding Syndrome

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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

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IV Nutrition

• Administration Monitoring PPN and TPN
• 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
• Frequent labs

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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

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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

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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

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Guest Speaker

• Bret Walters, RPh
• MVRMC Pharmacy TPN Expert