TPN- Dr.K

Enteral Nutrition:

• route

• pros

• cons

• route: oral, feeding tubes

• pros: easier, more natural, promotes/maintains gut fxn, less complications, less pricey

• cons: aspiration risk, diarrhea, uncomfy

Parenteral Nutrition:

• route

• pros

• cons

• route: IV (bypasses GI Tract)

• pros: gives an option for when GI tract is not functioning

• cons: harder, costly, higher infection/thrombosis risk, compromise GI Tract mucosa

What is the indication for initiating TPN?

unable to absorb adequate nutrition enterally for at least 5 days

Contraindications of TPN:

• functioning GI Tract

• no evidence of malnutrition or anticipated duration of PN less than 5 days

• no IV access

• terminal illness

What are the limitations of peripheral PN?

• osmolarity limit of ≤900 mOsm/L

Central administration is not limited by what like peripheral?

• pH, osmolarity, volume

Central administration has a higher risk of what complications compared to peripheral PN?

• infection

• occlusion

Fluid requirements/ the total fluid required per day includes what?

• PN

• maintenance fluids

• any other IV med

What is Basal Energy Expenditure (BEE)?

how much energy we use in the resting state

What is Total Energy Expenditure (TEE)?

total energy expenditures/ takes everything into account: resting, stress, activities

Caloric contribution of protein (PRN):

4 kcal/g

Caloric contribution of carbohydrates (PRN):

3.4kcal/gram

Caloric contribution of 10% Injectable Lipid Emulsion:

1.1 kcal/ml

Caloric contribution of 20% Injectable Lipid Emulsion:

2 kcal/ml

Caloric contribution of 30% Injectable Lipid Emulsion:

3 kcal/ml

Which 2 electrolytes are most at risk of binding and forming a precipitate?

Calcium and Phosphate

What can we do to reduce the risk of Calcium and Phosphate binding/forming a precipitate?

1. Calcium Gluconate > CaCl2

2. Add P to TPN 1st then Ca last

What type of insulin should be added to PN?

only REGULAR

Famotidine can be added to PN for…

stress ulcer prophylaxis

Limitation of peripheral administration for osmolarity:

osmolarity < 900

PN must run through a _______ filter.

1.2 micron

Hang time of lipids alone is _______ hours.

12

PN is classified as a ____________ medication by ISMP.

high-alert

To order PN a computerized order entry should be integrated with ____________________________________(ACD).

Automated compounding device

What is the difference between a 2-in-1 and 3-in-1 formulation?

• 2-in-1 has lipids in separately hung bag

• 3-in-1 has everything in same bag