Parenteral_NutritionBWF_10-1.pptx

Parenteral_NutritionBWF_10-1.pptx - Nutrition administered...

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10/18/10 Parenteral Nutrition Nutrition administered outside the the G.I. tract Administration by “vein” a.k.a. – PN , TPN, CVN, IVH Developed for patients with severe G.I. impairment Indicated for those unable to use oral diet or enteral nutrition Inability to use the gut at goal feeds within 5 days Severe pancreatitis Short bowel syndrome IBD GI fistulas Critically ill patients Very low birth weight infants Stem cell transplantation Should be delayed until pt is stable Could be life saving in certain situations Expensive Potentially dangerous Certification of medical necessity required
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10/18/10 Parenteral Nutrition Provision of nutrients directly into bloodstream - Intravenously Access Central parenteral nutrition (CPN) catheter in large, high- blood-flow vein such
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10/18/10 Routes of Parenteral Nutrition Peripheral access Up to 800 to 900 mOsm/kg Principle complication is thrombophlebitis Extended dwell catheter: 3 to 6 weeks Central Access Short-term central access Long-term central access Peripherally inserted central catheters (PICC)
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10/18/10 Formula Selection Based on Patient requirements Illness Organ failure Comorbid disease Estimation of nutritional needs IBW usually used for estimating needs Energy 25-30 kcals/kg (aim for 25kcals/kg) Metabolic cart on pts on TPN greater than 2 weeks Protein 1-1.8g/kg (aim for 1.5g/kg) Lipids 20-30% if total energy
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10/18/10 Included in the form of amino acids All essential amino acids, some nonessential Specialized solutions Concentration between 3% and 20% Designed to provide 0.8-1.8 g/kg 15% to 20% of kcals Requirement determined first Modified products for Renal failure Hepatic failure Stress These are rarely used due to cost and limited efficacy
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10/18/10 Lipids in Parenteral Solutions Generally an emulsion of soy or safflower oil Provides concentrated energy and EFA Minimum amount of 10% total energy High amounts limited due to inflammatory properties of n-6 PUFA 1-2g/kg generally used Available in 50 ml bags as ~10% emulsions = 1.1 kcal/ml ~20% emulsions = 2 kcal/ml Require 2% to 4% kcals as linoleic acid Amount infused at 10-30% of kcals
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10/18/10 Dextrose monohydrate (3.4 kcals/g) Available from 5 – 70% concentrations Adequate amount required to spare protein Minimum 100 grams ~ 1mg/kg/min Inadequate amounts cause protein catabolism Maximum rate should not exceed 3-5g/kg/min Excessive amounts should be avoided Refeeding syndrome Hyperglycemia Hepatic steatosis High R.Q Requirement for CHO determined by difference Fluid Typical prescriptions 1.5 to 3 L/day
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10/18/10 Electrolytes in Parenteral Solutions Amounts added based on Body weight Existing electrolyte deficiencies
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Parenteral_NutritionBWF_10-1.pptx - Nutrition administered...

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