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Parenteral Nutrition PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Parenteral Nutrition".

This medical PowerPoint presentation talks about parenteral nutrition (PN), a medical treatment that provides nutrients to patients who cannot consume food through the gastrointestinal tract. This may be due to various conditions such as cancer, inflammatory bowel disease, or surgeries that involve the removal of parts of the digestive system.

PN is administered directly into the bloodstream via a vein. The solution contains a combination of proteins, carbohydrates, fats, vitamins, minerals, and electrolytes, depending on the individuals needs. The formulation is customized to the patients nutritional requirements, taking into account their medical history and laboratory values.

PN is typically prescribed and managed by a team of healthcare professionals, including a physician, a registered dietitian, and a pharmacist. The treatment requires close monitoring of the patients clinical status, blood glucose levels, and electrolyte balance, among other parameters.

PN may be used as a short-term or long-term therapy, depending on the underlying condition. It is often used in critically ill patients who cannot tolerate enteral nutrition (feeding through the digestive tract) or in patients who require bowel rest. However, PN is associated with several complications, such as infections, liver dysfunction, and metabolic imbalances. Therefore, it should be used judiciously and under the supervision of experienced healthcare professionals.

Tags : parenteral nutrition, nutrients to patients, gastrointestinal tract, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 28, 2023 | Views : 2664 | Downloads : 10

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Slide 2-

Outline Introduction to parenteral nutrition (PN) Components of PN Types of nutrition administration Compounding techniques Referral and intake process Nutrition assessment Administration Management of nutrition support patients Physiologic and mechanical complications Special patient populations © 2016 Option Care Enterprises Inc. All rights reserved. 2
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Parenteral Nutrition (PN) PN is used for patients who have a functional impairment of the gastrointestinal tract that prevents nutrients from being absorbed well to maintain nutritional status The first patient received home infusion Parenteral Nutrition (PN) in 1968 The American Society for Parenteral and Enteral Nutrition (ASPEN) estimated that over 10,000 outpatients and 25,000-30,000 inpatients receive PN at a given time in the US PN was previously called Total Parenteral Nutrition (TPN) 4
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What are alternative care settings for home infusion? 5 Alternative care settings are outpatient options for infusion including: Patient homes Ambulatory infusion centers Physician-based infusion clinics Hospital-based infusion clinics Ambulatory infusion suite of the home infusion therapy provider
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Why a patient may need PN PN is only considered when adequate nutrition is not being maintained through the gastrointestinal tract Some reasons a patient may need PN include: Intestinal failure due to conditions such as Crohn’s Disease, Short Bowel Syndrome, etc. Acute pancreatitis Congenital conditions such as developmental failure Tumors Obstructions Secondary gastrointestinal effects from chronic diseases And so on 6
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What is needed for a patient to receive PN Before starting PN, certain patient criteria should be looked at Documented medical necessity Diagnosis and prognosis Possible complications from oral or enteral methods Previous unsuccessful attempts to treat by enteral route Precertification from third parties and Medicaid programs Does a patient with Medicare meet requirements set by Medicare 7
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What is needed for a patient to receive PN A written order from a licensed prescriber with components, quantities, volumes, infusion rates, type of infusion device, frequency, restrictions, nursing orders, etc. Baseline weight, height, vital signs, labs A complete medication list with prescriptions, OTCs, home remedies, supplements to be reviewed by a pharmacist Preferably before starting PN 8
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Components of PN Each PN is individualized to the patient and may contain: Protein in the form of amino acids Calories in the form of dextrose or combination of dextrose and fat Fluids Fat (lipid) emulsions Electrolytes – sodium, potassium, chloride, magnesium, phosphorous, acetate, calcium Vitamins – A, B, C, D, E, K, biotin, folic acid Trace metals – zinc, copper, manganese, chromium, selenium, iodine Other additives – iron, insulin, H2 blockers (e.g. ranitidine), heparin, albumin, metoclopramide, L-carnitine, choline 10
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Peripheral Parenteral Nutrition (PPN) Usually reserved for patients that need short term therapy (< 5-7 days) that do not suffer severe malnutrition, are not fluid restricted, and have good peripheral venous access Solutions contain diluted amino acids and electrolytes and dextrose or glycerol for calories May see formulations with fat emulsions as an additional calorie source 12
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Peripheral Parenteral Nutrition (PPN) Advantages Peripheral or midline placement instead of central line Commercially made solutions available Disadvantages Daily requirements cannot be met without a large volume Provides minimum calorie and protein Meant for short-term use only Can irritate peripheral veins and make it more difficult to maintain Frequent change of venous access is needed 13
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Parenteral Nutrition (PN) PN provides complete nutrition through a central line Previously known as “Total Parenteral Nutrition (TPN)” but shorted to PN Contains amino acids and glucose concentrations higher than can be used in peripheral parenteral nutrition May be referred to as “2 in 1” also Can contain electrolytes, vitamins, trace metals, and other additives as needed Fat emulsion is given separately from PN 14
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Parenteral Nutrition (PN) Advantages Adequate amounts of nutrients, calories, and volume to be used long term Can use a micron filter to filter out bacteria Can visually see if there are issues with the solution Disadvantages Has to be given through a central line Potential complications due to concentrations of components and rapid administration More line manipulations needed and greater risk of infection or human error More pumps, sets, and time needed Potential for non-compliance 15
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Total Nutrient Admixtures (TNA) Administration of complete nutrition through a central line Difference between PN and TNA is that the fat emulsion is added into the glucose and amino acid solution for TNA High concentration of glucose and amino acid requires use of a central line Also known as “all in one”, “3 in 1”, or “triple mix” 16
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Total Nutrient Admixture (TNA) 17 Advantages Contains adequate components to be used long term Fewer line manipulations needed than PN and less risk for infection and human error Simplified process (fewer pumps, sets, supplies needed) May lead to better utilization of lipids and may decrease insulin resistance Disadvantages Has to be given through a central line Not able to use bacteria micron filter Cannot visually see issues with solution Incompatible with many additives and some amino acids Large fat particles can block filter
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Cyclic PN Therapy Type of PN that is given over a limited number of hours Limited hours of infusion help free patient for activities of daily living Reserved for patients that are metabolically stable and can handle periods of infusion Cardiovascular and renal systems have to be able to handle increased volumes during infusion periods A patient may switch from continuous therapy to cyclic therapy by decreasing infusion time and increasing the rate Cyclic therapy can vary from 10 to 20 hours depending on the patient’s response and tolerance to infusion 18
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Cyclic PN Therapy Advantages Improved quality of life and compliance by allowing patient to resume normal daytime activities Can reduce liver problems because of rest period between infusions May help transition to oral diet by allowing hunger response to resume during non-infusion hours Disadvantages More nursing time may be needed at first to teach May not be appropriate for some patients if their cardiovascular system is not able to handle an increase in fluid volume during infusion hours May not be advantageous for patients that require strict “NPO” (nothing by mouth) 19
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Compounding It is necessary to use a laminar flood hood for PN PN has to be prepared under sterile conditions High Efficiency Particulate Air (HEPA) filters remove 99.97% of particles Flow of air sweeps the work area and prevents contamination Automated admixture devices Automated compounding devices are preferred because of increased accuracy and safety Requires less manipulation of final bag, streamlines inventory, and is less labor intensive Non-automated admixture Done by hand and follows a sequence of steps 21
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Initial Responsibilities Initial responsibilities Assessment in the hospital before discharge is helpful Introduction to patient, caregiver, family member is important Review patient chart and get necessary documents Coordinate with social work/case manager Determine if the patient is appropriate for home care Caregiver, significant other, or family member must be available and understand requirements Home environment and facilities must be adequate Reimbursement needs to be considered before starting Obtain the most recent PN order 24-hours before discharge Let patient, caregiver, and family member know when visiting nurse and delivery driver is scheduled to arrive 23
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Patient Visits 24 First visit Resources that are used include PN Patient Education guide and PN Clinical Nursing Pathway Assess patient, help ease anxiety levels, organize and prepare supplies Educate patient and caregiver about setup and how to use PN Second visit Continue to use teaching materials and checklists to assess and train patient Third visit Continue to assess patient Frequency of visits may depend on Acuteness of illness and patient ability to perform activities of daily living Learning style Anxiety level
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Nursing Interventions During Home Care Visits 25 Nurses can help in a variety of ways during home care visits including: Determining if the patient is having problems with administration/pump Obtaining blood samples Checking vital signs and completing physical assessments Providing emotional support and resources Reinforcing education or home PN procedures Reporting any physician visits, ER visits, hospitalizations, and any changes in medication to the health care team Assisting with arrangement for shipping Encouraging the patient to receive appropriate immunizations recommended by the doctor
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Nutrition Assessments are the cornerstone of PN 27 Optimally, a baseline assessment should be done before starting PN and periodically throughout the course of therapy A number of factors are analyzed during assessments including: Patient history Physical assessments Lab data Risk factors Effects of disease states or metabolism on nutritional status and requirements Anatomic and physiological functions and characteristics Estimates for nutrient requirements Goals of therapy
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Infusion devices 29 Patient needs and items to consider Pumps capable of large volume infusion rates Does the pump need to be ambulatory? Is the patient infusing at night only? Are their mobility problems? Can the patient carry two liters of formula if ambulatory? How is the pump powered? If battery, are they expensive, replaceable, rechargeable, readily available? Patient training materials Teaching sheets for specific pumps Manufacturer’s instruction material or training materials Filters All PN (without lipids) need a 0.22 micron filter All TNA solutions need a 1.2 micron filter Filters, tubing, PN formula must be changed every 24 hours and kept as a closed system whenever possible
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Management of Nutrition Support Patients 31 Routine monitoring Physical assessments, lab values, potential complications, teaching/learning, supplies Nutrition assessments Should be done at the start of care and periodically after Lab value assessments Coordinate lab draws and obtain copies of results for patient record Pharmacy assessments Review of physical assessments, nutritional assessments, lab data, nursing reports Determine if therapy is achieving results and if equipment is working properly
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Management of Nutrition Support Patients 32 Patient/caregiver self-monitoring assessments Patient/caregiver documentation must be put into the patient’s medical record Assess if patient/caregiver is reporting problems correctly Patient teaching Includes use of learning and teaching process steps, educational tools, teaching techniques A major goal of patient education is patient compliance Monitoring lab test results Each lab test has its own reference range for normal values Lab test and nutrition considerations Adjust components of PN as needed to be within the reference range for normal values
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Physiologic Complications 34 Complications that may occur with PN High blood sugar Low blood sugar Electrolyte imbalances Fluid overload Dehydration Acid base imbalance Allergic reaction Infection Liver function test abnormalities Overfeeding Gallbladder complications Refeeding syndrome
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Mechanical Complications 35 PN-catheter related Occlusions Dislodging of catheter Thrombus formation Subjective complaints such as discomfort in arm, neck, shoulder, or chest In-line filtration Lipid emulsion causing clogs of 0.22 micron filters TNA infusions require 1.2 micron filters
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Special Patient Populations 37 Nutritional requirements may need to be adjusted for different patient populations Pediatric patients Infants, children, and adolescents; typically birth to 18 years of age Dosing all components of PN can be critical in pediatrics Growth charts are used in addition to clinical pathways to monitor patients Elderly patients Over age 65 Loss of lean body mass, increase in total body fat, decrease in total body water Decrease in energy and calorie needs Pregnant patients with hyperemesis gravidarum Severe and persistent type of nausea and vomiting