parenteral nutrition

Nutritional Support:

Nutritional Support NUR 140 PPN and TPN Presented by: Karen Larson, MBA/TM, MSN, RN

Nutritional Support :

Nutritional Support Care of individuals with potential or known nutritional alterations Modes for delivery of nutritional support Enteral nutrition Peripheral parenteral nutrition (PPN) Total parenteral nutrition (TPN)

Parenteral Nutrition (PN):

Parenteral Nutrition (PN) Administration of nutrients by route other than the GI tract Uses the intravenous route to deliver nutritionally adequate nutrition

Goals of PN:

Goals of PN To provide all essential nutrients in adequate amounts to sustain nutritional balance during periods when oral or enteral feedings are not possible or are insufficient to meet caloric needs To preserve or restore the body’s protein metabolism and prevent protein or caloric malnutrition To diminish the rate of weight loss and to maintain or increase body weight To promote wound healing To replace nutritional deficits

Indications for PN:

Indications for PN Bowel surgery Chronic weight loss Coma Conditions requiring bowel rest Burns Critically ill patients Severe malnutrition Multiple trauma Albumin less than 3.5g/dl

Standard Parenteral Nutrition Components:

Standard Parenteral Nutrition Components Carbohydrates (dextrose) Protein (amino acids) Fat Electrolytes Vitamins Trace elements Water

Electrolytes and Vitamins:

Electrolytes and Vitamins Electrolytes given based on the patient’s metabolic status Potassium Magnesium Calcium Sodium Chloride Phosphorus Vitamins given for growth and maintenance, and multiple metabolic processes

Parenteral Nutrition Medication Additives:

Parenteral Nutrition Medication Additives Insulin Heparin Histamine 2 inhibitors Thiamine

Methods of Administration:

Methods of Administration Peripheral Parenteral Nutrition (PPN) Total Parenteral Nutrition (TPN)

Peripheral Parenteral Nutrition (PPN):

Peripheral Parenteral Nutrition (PPN) Nutrition provided by a large peripheral vein Used: Only when needed for short term (2-4 weeks) In patients who are already malnourished or have the potential for developing malnutrition and not candidates for enteral nutrition In stable patients who can tolerate high fluid volume To supplement oral intake In patients who are susceptible to catheter-related infections of central line TPN At a concentration no greater than 10% dextrose

Disadvantages of PPN:

Disadvantages of PPN Cannot be used in nutritionally depleted patients Cannot be used in volume-restricted patients Does not usually increase a patient’s weight Complications: Phlebitis Fluid overload

Total Parenteral Nutrition (TPN):

Total Parenteral Nutrition (TPN) Nutrition given thorough a central venous access device with a catheter tip that lies in the superior vena cava

Total Parenteral Nutrition (TPN):

Total Parenteral Nutrition (TPN) Used: For a longer period of time with a variety of central venous catheters To reverse starvation and adequately achieve tissue synthesis, repair, and growth To supplement oral intake At high concentrations greater than 10% dextrose In smaller fluid volumes

Advantages of TPN:

Advantages of TPN Dextrose of 20-70 percent administered as a calorie source Used for long-term (longer than 3 weeks) Used in patients with large caloric and nutritional needs Provides calorie, restores nitrogen balance, replaces vitamins, electrolytes, and minerals Allows bowel rest and healing Improves tolerance to surgery Is nutritional complete

Nutrient Admixtures:

Nutrient Admixtures

Nutrient Admixtures:

Nutrient Admixtures Saves time and money, is more patient specific Must be infused through 1.22 micron filter because of large fat/lipid particles

Preparation:

Preparation Pharmacists or trained technician Aseptic technique Nothing should be added after preparation Solutions are good for 24 hours and must be refrigerated before use

Administration:

Administration Strict aseptic technique when performing site care, cap or dressing changes Micron filter 0.22 for solution without fat emulsion Micron 1.22 filter for all-in-one solution containing fat emulsion All tubing and filters changed every 24 hours Label with date and time started

Nursing Management:

Nursing Management Vital signs q4 hours Daily weights Monitor blood sugar q4-6hrs Monitor blood levels Slowly or speeding up infusions rate is contraindicated Wean off once discontinued

Complications with PN:

Complications with PN Mechanical Pneumothorax Air Embolism Vein thrombosis Phlebitis Catheter Malposition Cardiac dysrhythmias Nerve injury Metabolic Rebound hypoglycemia Hyperglycemia Electrolyte imbalances Sodium Potassium Magnesium Phosphate Calcium

Complications with PN:

Complications with PN Infection Catheter-related sepsis