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June 6, 2017

Parenteral Nutrition Guide

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)

 

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