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Nutrition Support (2) - short

The document discusses parenteral nutrition (PN), including its components, delivery methods, and indications for short-term and long-term use. It outlines the necessary conditions for patients to receive PN, potential complications, and the importance of sterility, compatibility, and stability in IV admixtures. Additionally, it addresses metabolic and mechanical complications associated with PN and their management.

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4 views13 pages

Nutrition Support (2) - short

The document discusses parenteral nutrition (PN), including its components, delivery methods, and indications for short-term and long-term use. It outlines the necessary conditions for patients to receive PN, potential complications, and the importance of sterility, compatibility, and stability in IV admixtures. Additionally, it addresses metabolic and mechanical complications associated with PN and their management.

Uploaded by

eng.fathy94
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Dr Dina Hamdy Selim

• Components are in elemental or “pre-digested”


form .
• Delivery of nutrients intravenously, e.g. via the
bloodstream.
– Central Parenteral Nutrition: often called Total
Parenteral Nutrition (TPN); delivered into a central vein
– Peripheral Parenteral Nutrition (PPN): delivered into a
smaller or peripheral vein
Short-term use
• Bowel injury, surgery, major trauma or burns
• Bowel disease (e.g. obstructions, fistulas , Mesenteric
ischemia)
• Severe malnutrition
• Nutritional preparation prior to surgery.
• Malabsorption - bowel cancer
• Severe pancreatitis
• Malnourished patients who have high risk of
aspiration
Long-term use (Home PN)
• Prolonged Intestinal Failure
• Crohn’s Disease
• Bowel resection
• Patient has failed EN with appropriate tube placement
• Severe acute pancreatitis
• Severe short bowel syndrome
• Paralytic ileus (Obstruction of the intestine due
to paralysis of the intestinal muscles.)
• Small bowel syndrome(malabsorptive condition most
often caused by massive resection of the small intestine)
• GI fistula (abnormal opening in the digestive tract
that causes gastric fluids to seep through the lining of
the stomach or intestines) unless enteral access can be
placed distal to the fistula or where volume of output
warrants trial of EN
• Adults should be hemodynamically stable, able to
tolerate the fluid volume necessary to deliver
significant support, and have peripheral or central
venous access .

• If central access is not available, PPN should be


considered (more commonly used in neonatal and
peds population)

• Start slowly .
• Multiple Bottle System

• Two-in-one System ,Glucose System

• Three-in-one System, All-in-One


(AIO),Lipid system
➢ The pharmacy must maintain a clean
Sterility area out of the direct flow of traffic
(Contamination)
with a vertical or horizontal laminar air
flow hood to prepare IV admixtures
➢ Product sterility, overall integrity
also inspected.

Compatibility ➢ The various nutrients do not adversely


interact with one another throughout a
defined period of storage and delivery/
administration time.
➢ Design suitable alternatives when these
problem arise.
➢ No evidence of physical interactions
Stability ➢ The constituents of the admixture do not
degrade beyond a given acceptable range
over time.
➢ Stability information must be readily
accessible to the pharmacist in order to
determine optimum conditions for
storage prior and after preparation
➢ The stability at ideal storage conditions
will help to establish a reasonable
expiration date for the product.
➢ No evidence of chemical interactions .
• Functional and accessible GI tract
• Patient is taking oral diet
• Prognosis does not warrant aggressive nutrition
support (terminally ill)
• Fluid restriction (Renal or liver compromise)
❖Catheter-related complications
Catheter sepsis
Treatment:1- exclusion of other causes of fever
2- short course of anti-bacterial and antifungal
therapy
3- Catheter removal may be required
❖ Metabolic Complications
o Hyperglycemia : It can result in an osmotic diuresis
(abnormal loss of fluid), dehydration, hyperosmolar coma.
Treatment:
• Decrease the amount of infused glucose
• Insulin can be administered
o Hypertriglyceridemia
. Infusion of both glucose and fat emulsion in excess may
result in pulmonary insufficiency.
Excess glucose infusion –> excess carbon dioxide (CO2)
production a result of glucose metabolism.
Excess lipid infusion --> the lipid particles may accumulate.
o liver toxicity (cholestasis): It causes severe
cholestatic jaundice, elevation of transaminases,
and may lead to irreversible liver damage and
cirrhosis (high infusion rates of aromatic amino
acids, high proportion of energy intake from
glucose )
o Intestinal bacterial translocation:
altered permeability of the GI mucosa, allowing
bacterial entery to blood stream → sepsis
Prevention is to provide a minimal enteral nutrition
supply to avoid or minimize this risk.
❖Metabolic Complications
o Other metabolic complications:
Electrolyte imbalance, mineral imbalance,
acid-base imbalance, toxicity of
contaminants of the parenteral solution.
❖Mechanical Complications
Catheters and tubing may become clotted or
twist and obstruct.
Pumps may also fail or operate improperly.

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