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63 Cards in this Set
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what are some indications for PN
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post op ileus
short bowel syndrome GI fistula HEMODYNAMICALLY UNSTABLE |
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what is the daily range of dextrose
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2-7g/kg/day
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what is the infusion rate of dextrose
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<= 5mg/kg/min
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what are the essential fatty acids
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linoleic acid
linolenic acid |
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what is the daily range of IVFE
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0.5 - 1g/kg/day
don't usually og over 1g/kg/day b/c our fat emulsions are Omega 6 which can cause inflammation |
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what is the max daily range of IVFE
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2.5 g/kg/day
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what are the contraindications for IVFE
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severe egg allergy
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what is the phosphorous level in IVFE
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15 mmol/L of phosphorous
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if you have a hyperphosphatemic pt other than electrolytes where else can the phosphorous come from
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IVFE
protein |
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what are the hidden electrolytes in protein
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aminosyn II - 50meq Na/L
FreAmine and hepatamine/hepatasol - 10 mmol phos/L |
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what is the daily range of protein
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0.8 - 2g/kg/day
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when should vitamins be added to the PN solution
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as close to administration as possible (significant losses after 24hrs)
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if a pt is unaware of the timing for adding vitamins to the bag what vitamin would they lose rapidly and what can occur
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vit A deficiency which would result in NIGHT BLINDNESS
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when would a pt need increased Zn
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diarrhea losses
ostomy |
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if a pt has severe cholestasis (increased bilirubin) what micronutrients would you restrict
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copper
manganese |
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why is it discouraged to add FE for long term TPN
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iron is a trivalent cation and can disrupt the fat emulsion resulting in an unsafe and unstable formulation
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what are the types of solutions you can use in designing a PN regimen
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Total nutrient admixture (3in1)
Traditional (2in1) (dextrose/amino acid) solution |
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what is contained in total nutrient admixture
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everything INCLUDING IVFE all in one bag
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where is the on exception where it is acceptable to infuse IVFE over 12 hrs
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Total nutrient admixture (run for 24hrs)
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who is Total nutrient admixture unsuitable for
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infants and neonates b/c they require more Ca/PO4
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what kind of filter does total nutrient admixture use
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1.2 micron
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typically fat emulsions shouldnt be run longer than? why?
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typically not run longer than 12 hrs
this is b/c fat emulsions by themselves typically don't contain any preservatives therefore things can grow inside and you risk infection |
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what is inside traditional 2 in 1 solution
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everything but fat emulsion
this is good in that you don't have to worry about what cations are in the bag (Fe) and can simply piggy back the IVFE |
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what kind of PN would be the best choice for a pt with high electrolyte demand
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2in1
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what are advantages of TNA (3 in 1)
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decrease rate of contamination
decrease rate of microbial growth vs IVFE alone decrease pharmacy prep time and compounding supplies (all from same manufacturer) ease of administration requires 1 infusion pump (Y site fat in 2in1) |
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what are disadvantages of TNA (3 in 1)
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macronutrients from one manufacturer
CAN'T SEE PARTICULATE MATTER/PRECIPITATES DURING AND AFTER COMPOUNDING can't use 0.22 filter RISK OF IVFE INSTABILITY |
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what filter does 2in1 use
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0.22
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T/F all PN can be infused via peripheral line
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false
all PN can be infused via central line |
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you would use central PN when a pt is expected to need it for how many days
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>7-14 days
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how long if peripheral PN used
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<14 days
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what must be given with peripheral PN to improve tolerance
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24 hr IVFE
-can use TNA solution -or use 2in1 and do 2 seperate 12 hr piggy backs |
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whata re the fluid requirements of pheripheral PN
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2.5-3L/day
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how often do you have to rotate PIV in PN
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every 24 - 72 hrs
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what is the PN osmolality when given centrally and peripherally
and how much is protein and dextrose worth |
central > 900 mOsm
peripheral < 900 mOsm protein 10mOsm per g dextrose 5mOsm per g |
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what are the main types of peripheral IV
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PIV
Midline |
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what is a "hospital IV"
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PIV
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what IV line is inserted into a small peripheral vein in the hand, foot, arm, scalp
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PIV
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what IV line is inserted in the arm, BUT terminates in the proximal cephalic or basilic vein or distal subclavian vein
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Midline (typically terminates in shoulders or upper arm)
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which of the choices is PERCUTANEOUSLY PLACED IN SUBCLAVIAN, JUGULAR, OR FEMORAL VEIN and is it long or short term use
central venous catheters (CVC) peripherally inserted central catheters (PICC) tunneled central venous catheters implanted ports: Port A Cath (PAC) |
CENTRAL VENOUS CATHETERS (CVC)
short term use |
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which of the following is percutaneously inserted in the basilic, cephalic, or brachial veing with CATHETER TIP LOCATED/TERMINATES IN SUPERIOR VENA CAVA AT RIGHT ATRIUM and is it long or short term use
central venous catheters (CVC) percutaneously inserted central catheters (PICC) tunneled central venous catheters implanted ports: Port A Cath (PAC) |
percutaneously inserted central catheters (PICC)
short or long term use |
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Which one of the following is surgically placed, tunneled catheters for use > 4 weeks
central venous catheters (CVC) percutaneously inserted central catheters (PICC) tunneled central venous catheters implanted ports: Port A Cath (PAC) |
tunneled central venous catheters
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which of the following is SURGICALLY INSERTED UNDER THE SKIN IN THE CHEST, GROIN, ABDOMEN, ARM, OR THIGH AREA
central venous catheters (CVC) percutaneously inserted central catheters (PICC) tunneled central venous catheters implanted ports: Port A Cath (PAC) |
implanted ports: Port A Cath (PAC)
long term acess |
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PN containers and administration sets must be free of ___ b/c it can be extracted when IVFE are infused in PVC tubing
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di-2-ethylhexyl phthalate (DEHP )
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what is PN cycling and why is this done
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infusion of entire PN contents over 12-18 hrs with 1-2 hr taper off
this si done to mimic normal eating and give the liver a break |
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what are the possible complications of PN nutrition
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hyperglycemia (may be seen in acute pancreatitis)
hypoglycemia hypertrigyceridemia (this can cause acute pancreatitis) azotemia (can be a cause of encephalopathy) Essential fatty acid deficiency hepatobiliary dysfunction Refeeding syndrome volume overload mechanical and infectious complications vitamin and mineral deficiencies |
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glucose level of what is hyperglycemia in pts receiving PN
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>120
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glucose level of what is hypoglycemia in pts receiving PN
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<70
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how do you prevent hyperglycemia in pts receiving PN
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abide by max dextrose admin 2-7g/kg/day
abide by glucose infusion rate <4-5 mg/kg/min can tx by giving insulin as: -seperate infusion -w/ PN formulation -as a sliding scale |
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how much insulin is given to a PN pt with hyperglycemia
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1 unit every 10g dextrose
1 unit every 5g dextrose in DM pt/metabollic stress |
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how do you treat/prevent hypoglycemia in PN pt
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dextrose 50% 1 amp IV
dextrose 10% infusion if PN stopped (run this until bag i ready) Taper PN to off over 1-2 hrs so body can adjust to decrease dextrose |
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what pts are at risk of hypertriglyceridemia
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IVFE infusion rates >0.1 mg/kg/hr
IVFE OD |
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serum triglyceride of what concentration is considered hypetriglyceridemia
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>400 mg/dl
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how do you treat/prevent hypertriglyceridemia (TG >400)
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proper lipid infusion rate
hold IVFE and recheck TG level in 12-24 hrs alternate dosing schedule (3x weekly, every other day etc) |
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how do you manage Azotemia in PN pts
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adequate fluid provision (b/c may be due to dehydration)
reduction in protein administration renal replacement therapy lactulose for hepatic encephalopathy |
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what pts are at risk of Essential fatty acid deficiency
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NPO or IVFE free PN admin for > 20 days
neonates within 2 days of PN initiation |
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how do you treat/prevent EFAD
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administer atleast 100g IVFE weekly (20% 250ml IVFE 2x a week or 20% 500 ml IVFE weekly)
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if a pt has an egg allergy and can't receive IVFE what can you give them
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topical skin application of fat or oral oil ingestion
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how can pt get fatty liver (hepatobiliary dysfunction)
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feeding people too many callories and the body is unable to handle it and the liver turns into fat
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how can you treat hepatic steatosis (fatty liver)
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PN cycling (12-18 hrs)
decrease glucose/caloric admin |
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what is the cause of refeeding syndrome
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shift of fluids/electrolytes/minerals from ECF to ICF due to dextrose administration
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what must you monitor in refeeding syndrome
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lytes (Na, K, Mg, Phose - these may all decrease), thiamine deficiency (Wernicke's encephalopathy), edema
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how do you prevent/treat refeeding syndrome
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delay of PN initiation until electrolytes are corrected
conservative initial dose of dextrose: 2g/kg/day thiamine supplementeation (prior or with PN initiation) monitor electrolytes |
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what pts are at risk for refeeding syndrome
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alcholics
malnourished (anorexic) poor oral intake > 7 days severe metabolic stress |
