This document provides information about total parenteral nutrition (TPN), including:
- TPN involves administering nutrients intravenously to bypass the digestive system for patients who cannot eat or absorb nutrients normally. It provides all necessary nutrients like glucose, proteins, fats, vitamins and minerals.
- A central venous catheter is surgically placed in a large vein like the superior vena cava to administer high volumes and concentrations of nutrients. Strict sterility must be maintained to prevent infection.
- TPN requires balancing the nutrients and monitoring the patient closely as metabolic and fluid imbalances can occur if not managed properly. It is a medical intervention used when enteral nutrition is not possible.
In this presentation i have tried to explain in details about the Total Parenteral Nutrition (TPN) , what is it, who needs it, and how to prepare it and the necessary procedure with instructions. It is very useful for the individuals from Nutrition, Nursing, Pharmacists, and Medical background.
In this presentation i have tried to explain in details about the Total Parenteral Nutrition (TPN) , what is it, who needs it, and how to prepare it and the necessary procedure with instructions. It is very useful for the individuals from Nutrition, Nursing, Pharmacists, and Medical background.
Early Enteral Nutrition in Critically Ill Patients is the best for helping early recovery, decreasing hospital stay and decreasing malnutrition in ICU
How? When? Formulas used? Access forms?
This presentation will give an overview of what NG tube is, types of NG tube, indications and contraindications, how to insert NG tube and potential complications of NG tube
Early Enteral Nutrition in Critically Ill Patients is the best for helping early recovery, decreasing hospital stay and decreasing malnutrition in ICU
How? When? Formulas used? Access forms?
This presentation will give an overview of what NG tube is, types of NG tube, indications and contraindications, how to insert NG tube and potential complications of NG tube
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. Enteral nutrition
• the delivery of nutrients in liquid form directly into
the stomach, duodenum, or jejunum.
Parenteral nutrition
• administration of nutriment intravenously.
• nutrition which is delivered through a system other
than the digestive system.
Total Parenteral Nutrition (TPN)
• intravenous administration (via a central venous
catheter) of the total nutrient requirements of a
patient with gastrointestinal dysfunction.
3. Total Parenteral Nutrition
Also called central parenteral nutrition (CPN) or
‘hyperal’ (hyperalimentation).
[The term ‘hyperalimentation’ is a misnomer because it
incorrectly implies that nutrients are supplied in excess
of needs].
Large amounts of nutrients in a hypertonic solution can
be supplied via TPN. The catheter is surgically placed
into the superior vena cava.
The reason that larger amounts of nutrients in a
hypertonic solution can be supplied via the superior
vena cava than with peripheral parenteral nutrition is
that the superior vena cava has a much larger diameter
and a higher blood flow rate, both of which quickly
dilute the TPN solution.
4. Definition
Total parenteral nutrition (TPN) is a way of
supplying all the nutritional needs of the body by
bypassing the digestive system and dripping
nutrient solution/s directly into a vein.
The administration of a nutritionally adequate
hypertonic solution (consisting of glucose, protein
hydrolysates, minerals, and vitamins) through an
indwelling catheter into the superior vena cava or
other main vein.
Normally TPN is administered in a hospital, but
under certain conditions and with proper patient
and caregiver education, it may also be used at
home for long-term therapy (HPA).
Ideally, TPN provides all the nutrients in the
correct quantities to ensure the body functions
normally.
5. Types of PN
2 types of IV (or parenteral) nutrition.
Partial parenteral nutrition (PPN) :
- given for short periods of time,
- to replace some of the nutrients required daily and
only supplements a normal diet.
Total parenteral nutrition (TPN) :
- given to patients who can’t eat anything and must
receive all nutrients required daily through an
intravenous line.
Home parenteral nutrition (HPN) : usually requires a CVC
(central venous catheter), which must first be inserted in a
fully equipped medical facility. After it is inserted, therapy
can continue at home.
6. Parenteral nutrition is administered outside the
digestive tract, intravenously.
Enteral nutrition encompasses oral and tube feedings
into the digestive tract.
General rule : ‘if the gut works, use it’.
The GI tract should be used if possible because it tends
to atrophy when not used. Gut bacteria can translocate
to the circulatory system through an atrophied GI tract
and increase the risk of infection.
Peripheral parenteral nutrition (PPN) or
Peripheral venous nutrition (PVN)
nutrients are supplied via a peripheral vein, usually a
vein in the arm.
7. PPN feedings usually supplement enteral feedings.
Large amounts of nutrients cannot be supplied via a
peripheral vein, because these relatively small veins
cannot tolerate the rush of fluid into the vein that
occurs when a hypertonic solution is introduced into the
circulatory system.
Body fluids have an osmolarity of about 300 mOsm.
The introduction of a hypertonic solution into a body
compartment will cause an osmotic gradient, resulting
in a fluid shift.
WHAT HAPPENS ?
When a hypertonic solution is introduced into a small
vein with a low blood flow, fluid from the surrounding
tissue moves into the vein due to osmosis. The area
can become inflamed, and thrombosis can occur.
8.
9. Osmolarity of Solutions
Proteins and carbohydrates both contribute to
hypertonicity.
Fat being isotonic, can be administered peripherally.
However, if the patient has delayed lipid clearance, the
use of lipids is contraindicated.
Infusion of Peripheral Nutrition
The catheter is inserted into the arm vein of the
patient.
Up to 1800-2500 kcal and 90g protein can be supplied
via PPN.
This relatively high kcalorie/protein amount can be
supported peripherally only for a short period of time.
11. Purposes
Used when individuals cannot or should not get
their nutrition through eating.
Used when the intestines are obstructed, when the
small intestine does not absorb nutrients properly,
or a GI fistula (abnormal connection) is present.
To ensure ‘Bowel rest’ (food does not pass through
the bowels).
[Bowel rest may be necessary in Crohn's disease,
pancreatitis, ulcerative colitis, and with prolonged
bouts of diarrhea in young children].
12. Purposes (contd’)
Used for individuals with severe burns, multiple
fractures, and in malnourished individuals to
prepare them for major surgery, chemotherapy, or
radiation therapy.
Individuals with AIDS or widespread infection
(sepsis) may also benefit from TPN.
To rehydrate a patient post-viral illness.
Patients with more serious and long term illnesses
and conditions may require months or even years
of intravenous therapy to meet their nutritional
needs. These patients may require a central
venous access port.
13. A specialized catheter (Silastic Broviac or Hickman)
is inserted beneath the skin and positioned below
the collarbone. Fluids can then be injected directly
into the bloodstream for long periods of time. X-
rays are taken to ensure that the permanent
catheter is properly positioned.
14.
15. Description
The hyperalimentation solution is infused through
conventional tubing with an IV filter attached to remove any
contaminates.
In adults, the catheter is placed directly into the subclavian
vein and threaded through the right innominate vein into the
superior vena cava.
In infants and small children the catheter is usually threaded
to the central venous location by way of the jugular vein
(which is entered through a subcutaneous tunnel beneath
the scalp). Sometimes, the umbilical vein is used.
Strict asepsis must be maintained because infection (sepsis
and septicaemia) is the primary risk.
Once the catheter is in place, a CXR is done to make sure
the placement is correct.
TPN solution is mixed daily under sterile conditions.
16. Description (contd’)
Maintaining sterility is essential for preventing infection.
- The outside tubing leading
from the bag of solution to the
catheter must be changed
daily.
- The special dressings covering the catheter must be
changed every other day.
17. Contents of the TPN solution
Are determined / individualized, based on the individual
variables (age, weight, height, and the medical
condition/s) .
All solutions contain
- sugar (dextrose) for energy
- proteins (AA)
- fats (lipids)
- electrolytes (K+, Na+, Ca+, Mg+, Cl- and phosphate);
these are essential for normal body functioning.
- trace elements (Zn, Cu, Mn and Cr)
- vitamins
- insulin (helps the body use sugar), may need to be
added.
The TPN catheter is used only for nutrients;
medications are not added to the solution.
18. Contents of the TPN solution (contd.)
For Adults: approx. 2 lts of TPN solution daily (varies
with the individual’s age, size and health).
The solution should be allowed to be warmed to room
temperature before intravenous nutrition begins. The
solution is infused slowly at first to prevent fluid
imbalances, then the rate is gradually increased. The
infusion process takes several hours.
Successful TPN requires frequent, often daily
monitoring of the individual's parameters [weight,
glucose levels, FBC, blood gasses, fluid balance, urine
output, waste products in the blood (plasma urea);
electrolytes];
LFT & RFT may also be performed (special cases).
19. Conventional IV solutions are….
-sterile water with small amounts of sodium (salt) or
dextrose (sugar) supplied in bottles or thick plastic
bags that can hang on a stand mounted next to the
patient's bed.
-Additional minerals, vitamins, or drugs can be added
to the IV solution by injecting them into the bottle or
bag with a needle.
-These simple sugar and salt solutions can provide
fluids, calories, and electrolytes necessary for short
periods of time.
-If a patient requires IV feeding for more than a few
days, additional nutrients like proteins and fats will be
included. The amounts of each of the nutrients to be
added will depend on the patient's age, medical
condition, and particular nutritional requirements.
20. 3-in-1 solution : glucose,
proteins and lipids
Infusion:
Medical Infusion pump:
- preferred method (sterile bag of nutrient solution + pump)
- pump infuses a small amount (0.1 to 10 mL/hr)
continuously in order to keep the vein open.
- feeding schedules vary, but normally the regimen ramps
up the nutrition over one hour, levels off the rate for a few
hours, and then ramps it down over a final hour (in order
to simulate a normal metabolic response resembling meal
time). This should be done over 12 to 24 hours rather than
intermittently during the day.
Chronic PN is performed through a central IV catheter,
usually through the subclavian or jugular vein with the tip of
the catheter at the superior vena cava without entering the
right atrium.
21. PICC line :
- Peripherally Inserted Central Catheter
- originates in the arm, and extends to one of the
central veins (such as the subclavian with the tip in
the superior vena cava).
22. Preparation
Preparation to insert the catheter involves creating a sterile
environment. Other special preparations are not normally
necessary.
Aftercare
During the time the catheter is in place, patients and caregivers
must be alert to any signs of infection (redness, swelling, fever,
drainage or pain).
Risks
TPN requires close monitoring.
Two types of complications can develop as a result of inserting
the catheter into a vein …
* Pneumothorax (infection, air in the lung cavities)
* Thrombosis (blood clot formation) subsequent to phlebitis.
Metabolic and fluid imbalances
* occur if the contents of the nutritional fluid are not properly
balanced and monitored.
* Hypoglycemia – most common metabolic imbalance;
caused by abruptly discontinuing a solution high in sugar.
23. Risks (contd.)
If the needle becomes dislodged, it is possible that the
solution may flow into tissues around the injection site
rather than into the vein.
24.
25. NUTRITIONAL COMPONENTS
Amino Acid (AA) Solutions
Protein is provided as a crystalline amino acid solution.
500 ml bottles are standard.
Solutions vary in amino acid concentration and
composition.
The patient's protein needs determine the protein
concentration to use.
The underlying disease state/s determines the
composition of amino acids to use.
26. Solutions/Concentrati
ons
Amino acid (AA) solutions are generally available in the
following concentrations:
Percent Solution
(%)
3.0
AA Content
(g/100 mL)
3.0
3.5 3.5
5.0 5.0
7.0 7.0
8.5 8.5
10 10
27. Uses of Amino Acids
AAs do not normally contribute to the kcalorie
requirement of the patient (although they have 4 kcals
per gram).
Instead of being used for energy, amino acids should
be used for protein synthesis.
To determine protein needs, a nonprotein kcalorie to
nitrogen ratio of 80:1 to 150:1 is used.
• 80:1
• 100:1
• 150:1
Nonprotein kcal:N ratio
the most severely stressed patients
severely stressed patients
unstressed patient
28. Dextrose
Solutions
Dextrose in solution has 3.4 kcals/gram (rather than 4
kcals/gram as in dietary carbohydrates), because a
noncaloric water molecule is attached to dextrose
molecules.
Dextrose solutions come in different concentrations,
and the solution is abbreviated D(%solution)W.
Eg.: D50W indicates a 50% dextrose in water solution.
29. Dextrose Solution Concentrations
Dextrose solutions are available in the following
concentrations:
Percent soln. Dextrose Notation
(%)
5
(g/100 ml)
5 D5W
10 10 D10W
20 20 D20W
30 30 D30W
40 40 D40W
50 50 D50W
60 60 D60W
70 70 D70W
30. Infusion Rate
of Dextrose
Dextrose solutions should NOT be administered at a
rate higher than 0.36g per kg body weight/hour.
This is the maximum oxidation rate of glucose.
Excess glucose is converted to fat (which can result in
fatty liver).
The conversion of carbohydrate to fat can cause excess
CO2 production (which is undesirable for patients with
respiratory problems).
Calculation Example :
For 60 kgs patient,
0.36 x 60 kg x 24 hr = 518 grams per day
(Dextrose infusion should not be greater than 0.36g/kg/hr).
31. Calculate the maximum dextrose tolerance for the
following weights
Weight (kgs)
70
80
90
100
32. LIPID EMULSIONS
Lipids in PN are used as a source of essential fatty acids
(EFA) and energy.
Lipid emulsions are composed of soybean and/or
safflower oil, glycerol, and egg phospholipid.
Approx. 4% of total kcaloric intake should be EFAs to
prevent EFA deficiency.
IV lipids are a good source of kcalories for
hypermetabolic patients, or patients with volume or
carbohydrate restrictions (as they are isotonic and
calorically dense).
Lipids can provide upto 60% of non-protein calories.
Usually composed of long chain triglycerides (LCT).
In some cases, LCT + medium chain triglycerides
(MCT) may be beneficial.
33. F.Y.I.
Before lipids could be administered intravenously,
EFAs were provided by rubbing vegetable oil into the
patient's skin.
However, the efficacy of this procedure is
controversial, but it might be used in the case of patients
who cannot tolerate a lipid emulsion.
34. Lipid Emulsion Concentrations
IV lipids come in concentrations of 10% or 20%
emulsions.
The 10% emulsion contains 1.1 kcal/ml.
The 20% emulsion contains 2 kcal/ml.
Bottles come in 100 ml, 200 ml, 250 ml and 500 ml
volumes.
500 ml of 10% lipids given once or twice a week is
generally enough to prevent EFAs deficiency.
The lipid emulsion does not have to be mixed with the
AA and dextrose solutions in a single bag.
35. LIPID EMULSION ADMINISTRATION
Lipid emulsions are not provided continuously (to
prevent hyperlipidemia). This gives the body a chance
to clear lipids from the blood.
Usually, lipids are administered 1-2 times per week, but
can be provided daily, under stringent monitoring.
Recommended infusion times are 4-6 hours for 10%
lipids and 8-12 hours for 20% lipids.
12-24 hour infusions may be better tolerated by some
patients.
A total of 2.5g lipids /kg per day should not be
exceeded.
36. Calculation example of maximum daily lipids
For a 60 kg patient,
2.5g x 60 kg = 150g lipid per day maximum
Calculate maximum lipid tolerance for the following
weights:
Weight (kgs)
70
80
90
100
37. Evaluation of Lipid Tolerance
There are three methods that can be used for evaluation
of a patient's lipid tolerance:
Test Dose
Serum Triglycerides
Plasma Turbidity
38. Test Dose
Method
10% lipid infused @ 1ml/min for 15-30 min; if no
adverse symptoms, the rate can be increased to
80 - 100 ml/h
OR
20% lipid emulsion infused @ 0.5 ml/min for 15 –
30 min; if no adverse symptoms, the rate can be
increased to 40 - 50 ml/h
39.
Serum Triglyceride Method
Determine a baseline serum triglyceride level before
the emulsion is administered.
Determine the triglyceride level 8 hours after the
infusion has been terminated.
If serum triglycerides are normal or if they exceed
250 mg/day, lipids should be given at a reduced rate
or should be used only to prevent EFAs deficiency.
Plasma Turbidity Method
Plasma is observed for turbidity.
If turbidity is present, the lipid infusion must be
adjusted.
Not the best method for testing lipid tolerance,
because hyperlipidemia can occur without turbidity.
40. Contraindications for Lipid Emulsions
Abnormal lipid metabolism
Lipid nephrosis
Acute pancreatitis (if concomitant with or caused by
hyperlipidemia)
Severe egg allergies
Use lipid emulsions with caution if the patient has:
A blood coagulation disorder
Moderate to severe liver disease
Compromised pulmonary function
41. Administration of Lipids
Lipids are administered in a bottle that is ‘Y-connected’
(‘piggybacked’) to the IV line containing AA/dextrose
mixture.
Total nutrient admixtures (TNAs) also called ‘3-in-1
systems’, allow for lipids to be administered with AAs
and dextrose.
43. Mineral
State of Catabolism
Comments
(mEq)
Mild-Mod Severe
Give 5 - 6 mEq/g of N infused
Normal (mEq) (mEq)
Potassium 0.7 - 0.9 2.0 3.0 - 4.0
Sodium 1.0 - 4.0 2.0 - 3.0 3.0 - 4.0
Calcium 0.22 0.3 0.4
Phosphorous 0.3 0.8 1.2 - 2.0
Magnesium 0.3 0.3 - 0.4 0.6 - 0.8
0.25 m Eq/kg needed for calcium
equilibrium. Dependent on
simultaneous administration
of PO and Na, not N retention
Needs related to nitrogen
retention which is related to
kcal intake. Give 15-25 mEq
PO per 1000 dex kcals.
Give 2 mEq per gram of N
infused.
Mineral needs (Amount
per kg body weight)
45. Trace Elements
Requirements for standard trace element mixtures are
to be monitored and adjusted based on serum
concentrations.
Iron can be given intramuscularly as needed.
• When transferrin levels are low, free iron increases and
can increase susceptibility to infections.
• Critically ill or malnourished patients often have no
bone marrow response to iron.
Copper supplementation must be administered with
caution to avoid toxicity.
Extra zinc may be needed by some patients to promote
wound healing.
46. Element Dose
Zinc 2.5 - 4.0 mg
Copper 0.5 - 1.5 mg
Iron 1.0 mg
Chromium 10 - 15 mcg
Manganese 0.15 - 1.8 mg
Iodine 1 - 2 mcg
Selenium 20 - 40 mcg
47. Vitamins
The vitamin requirements for TPN patients are different
from non-TPN patients because absorption is not a
factor with TPN.
When needs are increased for certain disease states,
single vitamin supplements can be added to the
solution.
Serum vitamin levels can be monitored and dosage
adjusted accordingly.
Vitamin preparations should be added to the TPN
solution just prior to administration to avoid losses from
light exposure.