TPN concepts

Question 1

enteral nutrition

Answer 1

GI tract

• oral (swallow, tube feeding)
• if unable to swallow, tube into stomach or small intestine

Question 2

parenteral nutrition

Answer 2

• intravenous (large veins, eg, subclavian vein)

- total parenteral nutrition (TPN)

Question 3

TPN is…

Answer 3

total body nutrition, duh

• dextrose
• lipids
• amino acids
• electrolytes
• vitamins/minerals
• trace elements
• medications

Question 4

total parenteral nutrition: how long & what is it

Answer 4

• short or long term

- significant nutritional support

Question 5

peripheral parenteral nutrition: how long & what is it

Answer 5

• short term use only

- partial nutritional support

Question 6

MUST have before TPNing it up

Answer 6

• central venous catheter
• dedicated infusion port
• radiographic confirmation of placement

Question 7

TPN risks

Answer 7

• DVT
• infection
• cirrhosis
• pancreatitis, cholesystitis
• GI atrophy
• translocation of bacteria

Question 8

TPN initiation (how & why)

Answer 8

gradual, directed by TPN team

- prevent hyperglycemia!

Question 9

TPN discontinuation (how & why)

Answer 9

gradual, prevent hypoglycemia

- sudden? initiate dextrose infusion!!

Question 10

enteral feeding routes

Answer 10

• nasogastric tube

long-term:

• gastronomy tube
• jejunostomy tube, nasoduodenal, nasojejunal

Question 11

bolus feeding

Answer 11

250 - 400 mL solution rapidly administered through syringe or funnel into tube

• 4 to 6 times daily
• 10 minutes each feeding
• may not be tolerated (n/v/d, aspiration, abdominal cramp)
• usually for ambulatory

Question 12

intermittent enteral

Answer 12

administered every 3 to 6 hours over 30 to 60 minutes by gravity drip or pump infusion

• 300 to 400 mL solution given
• feeding bag used

Question 13

continuous feedings

Answer 13

• for critically ill
• for feedings into small intestine
• infusion pump (Kangaroo); slow rate over 24 hours
• 50 to 125 mL infused per hour

Question 14

cyclic method

Answer 14

continuous feeding infused over 8 to 16 hours daily

• for patients who are restless, greater risk of aspiration
• nighttime schedule = freedom for ambulatory patients

Question 15

major complication of enteral nutrition

Answer 15

aspiration pneumonitis

• may occur if patient fed while lying down or unconscious
• high fowler’s, check for gastric residual by aspirating

Question 16

major problem of enteral feeding

Answer 16

diarrhea

• could be caused by rapid admin, high caloric solutions, malnutrition, GI bacteria, drugs (Mg!)
• many oral liquid drugs are hyperosmolar (pull water into GI tract)

Question 17

average percentage of dextrose in TPN

Answer 17

25%