Parenteral Nutrition Lecture 11 Fall 2024 PDF

11/17/24 Parenteral Nutrition LEC TU RE 11 C LINIC AL NU TRITIO N ASSESSMENT AND INTERV ENTIO N FAL L 2024 1 1 Parenteral Nutrition v Provision of nutrients intr...

11/17/24 Parenteral Nutrition LEC TU RE 11 C LINIC AL NU TRITIO N ASSESSMENT AND INTERV ENTIO N FAL L 2024 1 1 Parenteral Nutrition v Provision of nutrients intravenously v Used in patients who are unwilling or unable to take adequate nutrients orally or through enteral nutrition support o patients who are already malnourished, or have the potential for developing malnutrition, AND who are not candidates for EN v Principal forms o Central: infused into a central vein (superior vena cava); mOsm/L > 900 o Peripheral: infused into a peripheral vein; mOsm/L maximum 600-900 2 2 1  11/17/24 3 3 Indications for PN v Non-functioning or inaccessible GI tract v Examples of clinical scenarios requiring PN o Short bowel syndrome o Non-operative mechanical bowel obstruction o Multiple enterocutaneous fistulae (ECF) o Paralytic ileus o Severe radiation enteritis o Small bowel transplantation (immediately postoperative) o Diarrhea refractory to medical interventions o Critical illness with poor enteral tolerance or accessibility o Multi organ dysfunction syndrome (MODS) o Major trauma or burns o Acute respiratory failure with ventilator dependency and GI malfunction 4 4 2  11/17/24 Short Bowel Syndrome v “A loss of intestinal surface for absorption of nutrients caused by the surgical removal of a section of the bowel” –Mosby’s Pocket Dictionary v Less than 180-200cm of functional small bowel remaining v Make up the majority of long-term home PN patients 5 5 Enterocutaneous Fistula v Fistula: communication between two epithelial surfaces o Enterocutaneous Fistula (ECF) § Between intestinal tract or stomach and skin § Contents leak out v 80% are due to surgery o Tumor, irradiation or inflammation v Classified regarding output o High (> 500 mL/day; small bowel) o Moderate (between 200 and 500 mL/day) o Low (< 200 mL/day; colonic) 6 6 3  11/17/24 Contraindications v Functional GI tract: if the gut works, use it!!! v Inability to obtain venous access v Not consistent with goals of care v Terminally ill § ethical consideration, favorable prognosis? § can be difficult hurdle for both professionals and patient/family v In situations when the risks outweigh the benefits 7 7 Peripheral Parenteral Nutrition (PPN) v Administration of large-volume dilute solution of nutrients peripherally, into a vein in the arm or back of the hand o The high osmolality of PPN may cause small veins to collapse o Short-term therapy (