Total parenteral nutrition
Safe medication administration Via FEEDING Tubes
As a critical care pharmacist, questions often come up about giving medications via an enteral tube. Dosage form, Liquid medications are often the best option if available. But point out that hyperglycemia may occur if sugar content in liquid meds is high. Plus GI side effects are possible with hyperosmolar medications (acetaminophen, potassium, etc) or sorbitol abo…
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Total parenteral nutrition
Make your ICU fluid stewardship
As a hospital pharmacist, you can improve fluid safety in the ICU, since fluids are used inappropriately in up to 20% of patients. Fluid stewardship aims to reduce harm by promoting judicious use during the “ROSE” phases r esuscitation or r escue, o ptimization, s tabilization, and e vacuation. Review fluids as you do other medications, right f…
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TPN
Lipid emulsions used in PN
As a critical care pharmacist, you may need to clarify the efficacy and safety of different lipid injectable emulsions ( Intralipid, Smoflipid , Omegaven, etc). IV lipids made only of soybean oil ( Intralipid, Nutrilipid ) have been our go-to for parenteral nutrition (PN) . But soybean is linked to inflammation, immunosuppression, and liver dysfunction. That's…
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TPN
Wait to start TPN in most critically ill adults
There's now stronger evidence for waiting to start parenteral nutrition in most critically ill adults. Waiting one week (7 days) to start parenteral nutrition instead of starting it right away reduces ICU stays by one day and hospital stays by two days. Patients who start parenteral nutrition later also have a lower risk for infections, less tim…
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TPN
Easy parenteral nutrition calculation
BACKGROUND ㅡ Parenteral nutrition (PN) prescriptions typically provide from 1 to 3 liters of fluid per day depending on the assessment of maintenance fluid requirements. A general rule of thumb is 30 mL/kg. Carbohydrates generally make up about 50% to 60% of the caloric prescription, at 3.4 calories/g of dextrose. Protein generally provides about 15% to 25% o…
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TPN
Total parenteral nutrition (TPN)
Overview ㅡ Parenteral nutrition (PN) involves delivery of nutrients by the intravenous (IV) route. Parenteral nutrition may be delivered by either the central (CPN) or peripheral (PPN) route. When delivered centrally, the feeding catheter is typically placed into the subclavian vein with the tip of the catheter near the opening of the right atrium. For PPN, the cath…
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Total parenteral nutrition
Use SMOFlipid as an alternative to traditional IV lipids
Smoflipid (0.2 g/mL) is indicated in adults as a source of calories and essential fatty acids for parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated. Smoflipid will compete with traditional lipids ( Intralipid , Nutrilipid ) for use in parenteral nutrition. Smoflipid is a 20% emulsion (…
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