Parenteral Nutrition (PN) Cheat Sheet
Please refer to the Parenteral Nutrition hospital policy on PROMPT via the hospital intranet.
HINTS:
The supervision of parenteral nutrition at NHE is carried out by the ICU team (ICU consultant, ICU liaison nurse) in consultation with the ward dietitian & pharmacist.
- For all referrals
- Please ensure the dietitian has reviewed your patient
- Complete the electronic referral form
- Contact the ICU Liaison nurse (#88225) or the ICU outreach consultant (#88228)
- The ICU team will come and see the patient and if indicated will prescribe peripheral (PPN) or total (TPN) parenteral nutrition
- If TPN is indicated, the home team will need to organise central access for the patient (please arrange for a dual lumen PICC line) placed by radiology
- PPN must be given via a dedicated 22g cannula in an appropriate site (as per pg 9 of the PN policy)
- The ICU team will round daily on the patient with the dietitian and prescribe
- a rate of therapy
- Any additional IV fluid that is required
- Electrolyte replacement
- Insulin therapy if needed (with occasional endocrine input)
- Multi-vitamins/thiamine as appropriate
- Blood tests
- Will be ordered by the ICU team
- Will be drawn at 6AM as needed
- To avoid your patient being phlebotomised un-necessarily
- For any additional blood test requests please contact the ICU team to add to the request form, rather than writing a separate request form
- Cessation of PN
- This is a joint decision between ICU, the dietitian and the home team
- To aid in communication, please document clearly and daily in your progress notes the surgical team’s view in terms of
- Nasogastric management (spigot, free drainage, remove)
- Enteral intake (NBM, sips, clear fluids, free fluids, light ward diet, full diet)
- Fluid & electrolyte management
- Please ensure the nursing staff weigh your patients regularly (minimum 3 times/week)
- The best way to achieve this is “prescribing” daily weight on the drug chart!
- Ongoing fluid and electrolyte management will be coordinated by the ICU team
Summary of Responsibilities
ICU team |
Home team |
TPN/PPN prescription |
Dietitian referral |
Prescribe other IV fluids as needed |
Organise PICC or appropriate cannula (for PPN) |
Electrolyte replacement |
Ensure patients weighed (daily initially) |
Insulin if needed |
QID bsls (for TPN pts) |
Blood tests |
Nasogastric management plan |
|
Diet plan (fast/sips/free fluids/clear fluids/diet) |