Ch. 21: Parenteral Nutrition Parenteral Nutrition: Delivery of nutrient solutions directly into a vein, bypassing the intestinal tract IV Nutrition can be tailored to individual needs Can provide water, amino acids, carbohydrate, fat and micronutrients

Rationale for Determining Feeding Route

Parenteral Nutrition Advantages Can provide total nutritional support for longer period of time Disadvantages of Parenteral Nutrition Costly Complications Sepsis Liver Kidneys Bone disorders Deficiencies

Parenteral Solutions, cntd. Intravenous nutrients Amino acids: essential and nonessential (branch-chained and aromatic) Carbohydrate: dextrose 3.4 kcal/gm Lipids: LCT or MCT, EFAs Micronutrients: prevention of deficiencies

Types of Intravenous Formulataions Types Intravenous Solutions Simple simple IV solutions typically contain 5 percent dextrose and/or normal saline (Normal saline is a solution of sodium and chloride in water) other electrolytes or salts may be added Complete complete nutrient solutions provide amino acids, dextrose, fatty acids, vitamins, minerals, and trace elements can be delivered into peripheral veins (the small-diameter veins that carry blood from the arms and legs) or central veins (the large-diameter veins located close to the heart)

Simple Intravenous Infusions used in medical conditions that disrupt acid base balance or fluid and electrolyte balance are delivered via a IV catheter through a peripheral forearm vein An IV catheter is a thin tube inserted into a peripheral or central vein. Additional tubing connects the IV solution to the catheter

Peripheral vs Total Parenteral Nutrition Compare the composition and uses of PPN andTPN Peripheral Parenteral Nutrition (PPN) Isotonic formula Contains all essential nutrients Requires renal functioning Short-term: 7-14 days Additional support for enteral feedings Used when TPN not possible

PPN and TPN, cntd. Total Parenteral Nutrition (TPN) Central Vein IV catheter in large central vein Highly concentrated solutions Long-term use High nutritional needs Client is severely malnourished Higher risk of infection

IV Nutrition What risks are associated with IV Nutrition? IV Nutrition Risks TPN requires surgical placement Peripheral veins—inflammation & infection TPN: Disease causing microorganisms introduced Complications on p. 526

IV Nutrition Proper way to administer PPN and TPN solutions PPN: Peripheral veins can collapse if concentration too high TPN: Feeding started slowly because of high glucose content and high osmolality of solutions Infusion pump required Hypoglycemia & hyperglycemia risks Electrolytes monitored vigilantly

Transition from Parenteral to Enteral Nutrition Appropriate transition from parenteral to enteral nutrition Villi will shrink and lose ability to function as a result of nonuse Slow reintroduction of enteral nutrition Transitional Feedings TPN tapered off gradually PPN doesn’t require tapering off

Transitioning, cntd. Rule of Thumb 1: Rule of Thumb 2: If clients can’t eat enough food to meet at least 50% of daily nutritional needs tube feedings should be considered. Rule of Thumb 2: Parenteral nutrition can be discontinued when at least 70-75% of energy needs are being met by oral intake, tube feedings or both

Home Nutrition Support Identify the benefits of and the criteria used to select candidates for home nutrition support Medical considerations Rational, stable personality Learning techniques, handling complications Compliant with recommendations Adequate financial resources & support

Practice Questions Types of formulas that contain complete proteins are called: Intact Hydrolyzed Modular Blenderized

Hydrolyzed formulas are given to clients who are able to digest and absorb nutrients without difficulty. True False

The primary purpose of a simple IV solution is to support all of the following EXCEPT: a. Help maintain fluid and electrolyte balance b. Help maintain adequate nutrient intake c. Help restore acid-base balance

Ideally a person should reach a severely-depleted state before TPN by central vein is initiated. True False