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Parenteral Nutrition
*Hyperto
nic solution causes water movement from the cell going to theareaof higher solute
concentration.
*Hypertonic solutions cause cells to shrink.
*anabolic state- state when the body builds and grows, a metabolic processthat
involves repair for growth and building.
Catheter Placement
Peripheral parenteral nutrition (PPN) - is not widely used because solutionsinfused into
peripheral veins must be isotonic (i.e., they must havelowconcentrations of dextrose
and amino acids) to prevent phlebitis andincreased risk of thrombus formation.
Because the caloric and nutritional value of PPN is limited, it is best suitedfor patients
who need short-term nutrition support (7–10 days) and do not requiremore than 2500
cal/day. PPN is contraindicated in patients who needafluidrestriction, such as in
patients with renal failure, liver failure, or congestiveheart failure.
Central PN infuses a hypertonic, nutritionally complete solution throughalarge
diameter central vein so that it is quickly diluted. A physician threadsa
central venous catheter through the jugular or subclavian vein until
thetipislocated just above the heart.
Specially trained nurses can place a peripherally inserted central catheter (PICC) at
bedside.
The line is usually inserted on the inside of the elbow and threaded sothetipof the
catheter rests at the superior vena cava.
Composition of PN
Heparin may be added to reduce fibrin buildup on the catheter tip. In general,
medications should not be added to PN solutions because of the potential
incompatibilities of the medication and nutrients in the solution.
PN is infused slowly (i.e., 1 L in the first 24 hours) to give the body timetoadapt to the
high concentration of glucose and the hyperosmolality of thesolution. After the first 24
hours, the rate of delivery is gradually increasedby1 L/day until the optimal volume is
achieved.
Continuous drip by pump infusion is needed to maintain a slow, constant flowrate. If
the rate of delivery falls behind or speeds up, the drip rate is adjustedto the correct
hourly rate only; no attempts are made to “catch up” totheordered volume.
For stable patients who require long-term or home PN cyclic PNinsteadof
continuous PN.
When it is given during the night, cyclic PN frees the patient to participateinnormal
activities during the day.
When the patient is able to begin consuming food enterally (orally or by tubefeeding),
the amount of PN is gradually reduced to compensate for calories
consumedenterally. It is recommended that PN be discontinued when enteral
feedingprovides more than 60% of calorie goals (McClave et al., 2009).
References:
Dudek, S.G. (2014). Nutrition Essentials for Nursing Practice. Lippincott Williams &Wilkins.
Audrey B., Snyder S., Frandsen G.(2016). Kozier & Ebs Fundamentals of Nursing.
Pearson Education Inc.