1. 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

2. Rationale for Determining Feeding Route

3. 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

4. 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

5. 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)

6. 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

7. 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: days
Additional support for enteral feedings
Used when TPN not possible

8. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

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

17. 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

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