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