Weaning Long term (pn ppt)

Weaning - Rationale

Taper PN to prevent rebound hypoglycemia and allow metabolic adaptation as oral/enteral intake increases.

Weaning - Readiness Criteria

Oral/enteral intake consistently provides 50-75% of estimated caloric/protein needs; stable hemodynamics; tolerable GI function.

Weaning - Taper Strategy

Reduce PN rate by 10-25% every 2-4 hours while monitoring BG; consider adding D10-D20 if hypoglycemia risk.

Weaning - BG Precaution

Monitor blood glucose before taper, during taper (q2-4 hr), and 4-6 hr after PN off; treat symptomatic hypoglycemia per protocol.

Weaning - Hypoglycemia Prevention

Never stop PN abruptly; keep dextrose source available; coordinate mealtimes or enteral feeds during late taper.

Weaning - Electrolyte Monitoring

Check K⁺, Mg²⁺, and PO₄³⁻ during taper, particularly in malnourished clients or those previously at risk for refeeding.

Weaning - Documentation

Record taper schedule, BG values, symptoms, and any dextrose interventions; communicate plan to next shift.

Oral/Enteral Reintroduction - Sequence

Start with clear, low-fat liquids → advance to full liquids → soft diet → regular as tolerated.

Oral/Enteral Reintroduction - Tolerance

Monitor for N/V, abdominal distention, diarrhea/constipation, and residuals (if enteral); hold/slow advance if intolerance occurs.

Oral/Enteral Reintroduction - Protein Focus

Prioritize protein intake to support nitrogen balance and wound healing; consider high-protein oral supplements.

Oral/Enteral Reintroduction - Hydration

Track I&O; maintain adequate fluid intake to avoid dehydration during transition off PN.

Long-Term PN - Catheter Care

Use strict aseptic technique for all access; change dressings per protocol; inspect for erythema, drainage, or tenderness daily.

Long-Term PN - Filter/Bag Changes

Change PN bag/tubing every 24 hr; do not "top off" bags; use micron filter for PN (not with lipids).

Long-Term PN - Lipid Administration

Administer lipids via separate line or as 3-in-1 if prescribed; hold lipids if triglycerides >400 mg/dL.

Long-Term PN - BG Management

Check BG at least daily when stable; increase frequency with changes in rate/formula, illness, or steroid use.

Long-Term PN - Weight & I&O

Obtain weight 2-3 times per week at home or daily inpatient; track I&O to detect fluid imbalance.

Long-Term PN - Medication Review

Reconcile meds regularly for agents affecting glucose or electrolytes (steroids, diuretics, insulin).

Monitoring Schedule - Initial (Inpatient)

Daily: BMP (Na⁺, K⁺, Cl⁻, CO₂, BUN, Cr), Ca²⁺, Mg²⁺, PO₄³⁻, glucose; Weekly: triglycerides, LFTs; Twice weekly: prealbumin when malnourished.

Monitoring Schedule - Stable (Home)

Weekly for 2-4 weeks: BMP, Mg²⁺, PO₄³⁻, glucose; Then every 2-4 weeks if stable. Monthly: LFTs, triglycerides. Every 1-3 months: prealbumin/albumin and CBC.

Monitoring Schedule - After Changes

Check labs within 24-72 hr after any significant PN composition or rate change.

Monitoring - Target Goals

Prealbumin 15-36 mg/dL, BUN 10-20 mg/dL, triglycerides <400 mg/dL, BG 140-180 mg/dL (inpatient target).

Home PN - Storage

Refrigerate PN bags; remove 1-2 hr before use to warm to room temp; protect from light if indicated.

Home PN - Pump Use

Program pump per prescription; verify rate and volume; respond to alarms promptly; keep spare batteries and supplies.

Home PN - Line Access

Hand hygiene, mask, sterile cap changes, scrub-the-hub; minimize line entries to reduce infection risk.

Home PN - Air Embolism Prevention

Clamp line before disconnections; ensure all connections are secure; use air-in-line alarms.

Home PN - Emergency Plan

Keep backup D10-D20, supplies, and contact numbers available; know signs of hypoglycemia, infection, and air embolism.

Home PN - Travel Considerations

Carry letters/prescriptions; keep PN on cold packs; bring extra supplies, batteries, and a backup dextrose source.

Lifespan - Pediatric

Use weight-based calculations; frequent BG/electrolyte checks; teach caregivers sterile technique and pump troubleshooting; coordinate school schedules.

Lifespan - Older Adult

Monitor for fluid overload, heart failure signs, and cognitive barriers to self-care; simplify instructions and verify teach-back.

Lifespan - Renal/Hepatic Disease

Adjust electrolytes (K⁺, Mg²⁺, PO₄³⁻) and protein as indicated; monitor LFTs/Cr closely; coordinate with nephrology/hepatology.

Readmission/Complication Prevention

Schedule routine follow-ups; reinforce aseptic technique; review sick-day rules (increase BG checks, call for fever or BG extremes).

Quality & Safety Checklist

Right solution, right rate, right filter, sterile technique, daily weight, BG monitoring, scheduled labs, documented education and teach-back.