Parenteral Nutrition

1
Chapter 18

• Parenteral Nutrition

2
Peripheral Parenteral Nutrition (PPN)

• Short term use (7-14 days)
• NOT for severely malnourished
• Need strong veins
• High source of fat
• Lots of fluid

3
Total Parenteral Nutrition (TPN)

• Longer term use
• More flexible with
• Nutrients
• Fluid
• GOOD for malnourished individuals
• Concentrated or dilute
• Major infection risk

4
Nutrients

• Protein
• Must be supplied as free amino acids
• Branched chain available for hepatic patients
• Not used as a calorie source

5
Nutrients

• Carbohydrates
• Given as Dextrose (D5, D10, D20)
• 3.4 kcals/gram

6
Nutrients

• Lipid
• Can be given daily, QOD or weekly to meet ESFA
  needs
• 500 ml bottle of 10 fat provides 550 kcals (1.1
  kcals/mL)
• 500 ml bottle of 20 fat provides 1,000kcals (
  2.0 kcals/mL)

7
Nutrients

• Micronutrients
• MVI given daily or QOD in bag
• Vitamin K added once/week
• Calcium and Phosphorus must monitor for
  precipitate formation
• Electrolytes be careful to adjust based on labs

8
Nutrients

• Drugs
• Not generally good to add drugs to bag unless a
  stabilized dose that is compatible with formula

9
Refeeding Syndrome

• Malnourished person
• Fed too quickly
• Leads to
• Malabsorption
• Cardiac insufficiency
• Respiratory distress
• CHF
• Death