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63 Cards in this Set

  • Front
  • Back
what are some indications for PN
post op ileus
short bowel syndrome
GI fistula
HEMODYNAMICALLY UNSTABLE
what is the daily range of dextrose
2-7g/kg/day
what is the infusion rate of dextrose
<= 5mg/kg/min
what are the essential fatty acids
linoleic acid
linolenic acid
what is the daily range of IVFE
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
what is the max daily range of IVFE
2.5 g/kg/day
what are the contraindications for IVFE
severe egg allergy
what is the phosphorous level in IVFE
15 mmol/L of phosphorous
if you have a hyperphosphatemic pt other than electrolytes where else can the phosphorous come from
IVFE
protein
what are the hidden electrolytes in protein
aminosyn II - 50meq Na/L
FreAmine and hepatamine/hepatasol - 10 mmol phos/L
what is the daily range of protein
0.8 - 2g/kg/day
when should vitamins be added to the PN solution
as close to administration as possible (significant losses after 24hrs)
if a pt is unaware of the timing for adding vitamins to the bag what vitamin would they lose rapidly and what can occur
vit A deficiency which would result in NIGHT BLINDNESS
when would a pt need increased Zn
diarrhea losses
ostomy
if a pt has severe cholestasis (increased bilirubin) what micronutrients would you restrict
copper
manganese
why is it discouraged to add FE for long term TPN
iron is a trivalent cation and can disrupt the fat emulsion resulting in an unsafe and unstable formulation
what are the types of solutions you can use in designing a PN regimen
Total nutrient admixture (3in1)
Traditional (2in1) (dextrose/amino acid) solution
what is contained in total nutrient admixture
everything INCLUDING IVFE all in one bag
where is the on exception where it is acceptable to infuse IVFE over 12 hrs
Total nutrient admixture (run for 24hrs)
who is Total nutrient admixture unsuitable for
infants and neonates b/c they require more Ca/PO4
what kind of filter does total nutrient admixture use
1.2 micron
typically fat emulsions shouldnt be run longer than? why?
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
what is inside traditional 2 in 1 solution
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
what kind of PN would be the best choice for a pt with high electrolyte demand
2in1
what are advantages of TNA (3 in 1)
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)
what are disadvantages of TNA (3 in 1)
macronutrients from one manufacturer
CAN'T SEE PARTICULATE MATTER/PRECIPITATES DURING AND AFTER COMPOUNDING
can't use 0.22 filter
RISK OF IVFE INSTABILITY
what filter does 2in1 use
0.22
T/F all PN can be infused via peripheral line
false

all PN can be infused via central line
you would use central PN when a pt is expected to need it for how many days
>7-14 days
how long if peripheral PN used
<14 days
what must be given with peripheral PN to improve tolerance
24 hr IVFE
-can use TNA solution
-or use 2in1 and do 2 seperate 12 hr piggy backs
whata re the fluid requirements of pheripheral PN
2.5-3L/day
how often do you have to rotate PIV in PN
every 24 - 72 hrs
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
what are the main types of peripheral IV
PIV
Midline
what is a "hospital IV"
PIV
what IV line is inserted into a small peripheral vein in the hand, foot, arm, scalp
PIV
what IV line is inserted in the arm, BUT terminates in the proximal cephalic or basilic vein or distal subclavian vein
Midline (typically terminates in shoulders or upper arm)
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
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
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
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
PN containers and administration sets must be free of ___ b/c it can be extracted when IVFE are infused in PVC tubing
di-2-ethylhexyl phthalate (DEHP )
what is PN cycling and why is this done
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
what are the possible complications of PN nutrition
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
glucose level of what is hyperglycemia in pts receiving PN
>120
glucose level of what is hypoglycemia in pts receiving PN
<70
how do you prevent hyperglycemia in pts receiving PN
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
how much insulin is given to a PN pt with hyperglycemia
1 unit every 10g dextrose
1 unit every 5g dextrose in DM pt/metabollic stress
how do you treat/prevent hypoglycemia in PN pt
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
what pts are at risk of hypertriglyceridemia
IVFE infusion rates >0.1 mg/kg/hr
IVFE OD
serum triglyceride of what concentration is considered hypetriglyceridemia
>400 mg/dl
how do you treat/prevent hypertriglyceridemia (TG >400)
proper lipid infusion rate
hold IVFE and recheck TG level in 12-24 hrs
alternate dosing schedule (3x weekly, every other day etc)
how do you manage Azotemia in PN pts
adequate fluid provision (b/c may be due to dehydration)
reduction in protein administration
renal replacement therapy
lactulose for hepatic encephalopathy
what pts are at risk of Essential fatty acid deficiency
NPO or IVFE free PN admin for > 20 days
neonates within 2 days of PN initiation
how do you treat/prevent EFAD
administer atleast 100g IVFE weekly (20% 250ml IVFE 2x a week or 20% 500 ml IVFE weekly)
if a pt has an egg allergy and can't receive IVFE what can you give them
topical skin application of fat or oral oil ingestion
how can pt get fatty liver (hepatobiliary dysfunction)
feeding people too many callories and the body is unable to handle it and the liver turns into fat
how can you treat hepatic steatosis (fatty liver)
PN cycling (12-18 hrs)
decrease glucose/caloric admin
what is the cause of refeeding syndrome
shift of fluids/electrolytes/minerals from ECF to ICF due to dextrose administration
what must you monitor in refeeding syndrome
lytes (Na, K, Mg, Phose - these may all decrease), thiamine deficiency (Wernicke's encephalopathy), edema
how do you prevent/treat refeeding syndrome
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
what pts are at risk for refeeding syndrome
alcholics
malnourished (anorexic)
poor oral intake > 7 days
severe metabolic stress