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Parenteral NS

Parenteral NS. Fluid and electrolyte requirements. Calculate enteral and parenteral formulations. PNS Routes. Peripheral access Short-term central access Long-term central access. Peripheral Access. Veins in limbs Cannot exceed 800-900 mOsm/kg

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Parenteral NS

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  1. Parenteral NS • Fluid and electrolyte requirements. • Calculate enteral and parenteral formulations.

  2. PNS Routes • Peripheral access • Short-term central access • Long-term central access

  3. Peripheral Access • Veins in limbs • Cannot exceed 800-900 mOsm/kg • PICC - enter at peripheral but end of tube at subclavian vein

  4. Central Access • Figure 20-3 here • Cephalic vein • Subclavian vein • Internal jugular vein • Superior vena cava

  5. Fig. 20-3. Central access

  6. Central Access • Short-term • percutaneous technique • Long-term • implanted vascular devices

  7. PNS • Time frame for use of PNS • 5 days or less is short-term • Total nutrients needed • Capacity of pt to handle fluid

  8. PNS • Condition of peripheral veins • If can take adequate oral intake in 5 day - DO NOT do central line

  9. PNS Components • Protein • crystalline amino acids • 3% to 15% solutions • 10% = 100g protein/L • 4 kcal/g protein • NPC non-protein calories

  10. PNS Components • Carbohydrate • dextrose monohydrate • 5% to 70% solutions • D50W = 50% solution • 10% solution = 100g/L • 3.4 kcal/g dextrose

  11. PNS Components • Lipid • soybean or safflower oil • 10%, 20% & 30% solutions • 10% = 1.1 kcal/ml • 20% = 2.0 kcal/ml • 30% = 3.0 kcal/ml

  12. PNS Components • Lipid • 10% kcal/day every day will provide 4% of kcal need to prevent EFA deficiency • if have long chain fatty acids

  13. PNS Components • Electrolytes, vitamins, minerals

  14. PNS • PPN • less than 8.5% AA • 5-10% dextrose • lipid not more than 1g/kg/day

  15. PNS • PPN • Rule of thumb for PPN • D5W or D10W with 8.5% AA • D20W with 5% AA and lipid at 125 ml/hr

  16. PNS • Compounding methods • mix the dextrose and AA • ‘piggy’ back the lipid and filter before mix with dextrose and AA

  17. PNS • Initiating TPN • start less than 50 ml/hr and 1 L/day • advance 12 - 24 hr intervals

  18. PNS • Monitoring • amount receiving • Na • K • BUN • prealbumin

  19. PNS • Monitoring • cholesterol • TG • I & O • body wt • blood glucose

  20. McClaren 165. Essential fatty acid deficiency.

  21. McClaren 166. Same pt. 165 after EFA supplementation.

  22. Complications TPN • Catheter in wrong place • Sepsis • Deficiencies • EFA def • trace minerals - added routinely

  23. Complications TPN • Metabolic complications • overloading • imbalances

  24. Complications TPN • Overloading • solute or fluid - meas. Serum osmolality • CHO, fat, amino acids

  25. Complications TPN • Imbalances • glucose intolerance • hypokalemia • reactive hypoglycemia • hypophosphatemia • hypo or hypermagnesemia

  26. Refeeding Syndrome • Too aggressive administration after ‘starving’ • Hypokalemia • Hypophosphotemia

  27. Transition Feeding • Parenteral to enteral • start enteral slow • keep TPN going & decrease as increase enteral • receive 75% from enteral before stop TPN

  28. Transition Feeding • Parenteral to oral • start oral and slowly decrease TPN • be careful of hyperosmolality of common clear liquids • receive 75% of needs before stop TPN

  29. Transition Feeding • Enteral to oral • ?? • mOsm/kg for different clear liquids be careful not too high

  30. TPN END • Questions? • Now for calculations

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