https://docs.google.com/document/d/1VFAms16Rm2-6YENIkAhhtsxRLAt3XlnY/edit
EN: Water Flush
EN: kcal - FW = mL of water flush
Enteral Tube Feedings
Calculate estimated needs CHO, Protein, Fluid
Select TF formula
Choose caloric level starting point
How much TF to meet caloric needs
Example: 1400 desired kcals / 1.2 kcals/ml = 1167 ml formula needed
See if CHO, Protein, & Fat will meet pt needs
Convert TF from ml into L
Multiply L of TF with Protein (g)
Determine rate of TF
Determine free water in TF
mL of water in TF / 1000 = %
mL of TF (#6 rounded) * #7a. = mL free water delivered in x ml of formula
Amount additional water is needed to meet estimated fluid needs
x ml fluid needed – x (#7b) ml free water in TF = x ml additional free water needed
Divide the free water
BID | TID | QID
Write final TF order
TPN: Lipid solutions
1.1 @ 10% OR 2 @ 20%
TPN: Protein
4
TPN: CHO
3.4
TPN: Fat
10
3 in 1 —> D15%, AA4.25%, IL3.2% at 70ml/hr.
volume of TPN = 1680ml
grams / kcal from CHO = 252gCHO / 856.8kcal
grams / kcal of protein = 71.4g AA / 285.6kcal
grams / kcal for IL = 53.76g IL / 537.6kcal
total kcal = 1680kcal
CHO Infusion rate = 252g CHO ÷ 79kg (pt weight) ÷ 1440 (min/day) x 1000 (mg/g) = 2.2mg/kg/min
TPN: CHO Infusion
Measures how much CHO is oxidized
g CHO ÷ kg (pt weight) ÷ 1440 (min/day) x 1000 (mg/g) = mg/kg/min
TPN: 2 in 1 — > D25%, AA5.5% at 50ml/hr. 10% IL at 10ml/hr x 12 hr
volume of dextrose/AA solution = 1200ml/d
grams / kcal from CHO = 300g CHO / 1020kcal
grams / kcal of protein = 66g AA / 264kcal
volume / kcal /grams of IL = 120 mL / 132kcal / 13 gm
Total: 1416kcal/d
CHO infusion rate = 300g CHO ÷ 58kg (pt weight) ÷ 1440 (min/day) x 1000 (mg/g) = 3.6mg/kg/min
TPN: Dual Chamber Bag = Fat in upper chamber & dextrose and AA in lower
D20%, AA5%, 150ml 20% IL at 65ml/hr
volume of TPN = 1560ml/d
grams / kcal from CHO = 282g CHO / 959kcal
grams / kcal of protein = 70g AA / 280kcal
kcal /grams of IL = 300kcal / 30 gm
Total: 1539kcal/d
CHO Infusion rate: 282g CHO ÷ 79kg (pt weight) ÷ 1440 (min/day) x 1000 (mg/g) = 2.5mg/kg/min
TPN: Initial Concentration —> 420ml D70, 700ml AA 15%, 200ml 20% IL
grams / kcal from CHO = 294g CHO / 1000kcal
grams / kcal of protein = 105g AA / 420kcal
kcal /grams of IL = 400kcal / 40 gm
Total: 1820kcal/d
CHO infusion rate: 294g CHO ÷ 84kg (pt weight) ÷ 1440 (min/day) x 1000 (mg/g) = 2.4mg/kg/min
TPN: Propofol
1.1kcal/ml