Parenteral Nutrition: Premixed Solution Case Studies
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- เผยแพร่เมื่อ 19 ก.ย. 2024
- Want to see how an RDN might select premixed parenteral nutrition solutions? Today we're walking through three different patient profiles and choosing premixed PN and injectable lipid emulsion options for each.
Calculation note:
Thanks to the helpful viewer that let us know our calculations are wrong for the dextrose content of the Bag C + D option for Patient 3. Bag C is indicated as 110g dextrose, and Bag D has 144g dextrose, which should have put our total at 254g dextrose and not 154g.
Got questions? Leave them in the comments below!
Want to learn more about what premixed PN solutions look like? Check out our introductory video here: • Premixed PN Solutions ...
Closed captions provided by Ali Mathews.
Really great content. Thank you. How can we calculate free water in enteral and perenteral formulations? I couldn't find the exact answer on internet. Thank you in advance
Hello!
For commercial enteral formulas, the free water in the formula will be reported as a part of the nutrition facts (typically under 'Water, g/mL' or a percentage of the total formula that is free water, like 72% or something similar). Calculate the total quantity of EN you are providing per time period, then assess how many "servings" of EN you are providing total. Take that number and multiply by the quantity of water per serving. (example: if you are feeding 1.2 L of formula with 750 mL free water per 1L, 1.2 * 750 mL = 900 mL free water)
For commercial, premixed parenteral nutrition solutions, they will also have nutrition information available including the 'free water content' of a bag of PN. For custom PN bags, the total water content of the bag will be highly dependent on the contents of the bag, the osmolarity, and other customized factors. The pharmaceutical compounder would be the most able to provide this free water information for each custom bag.
Hope this helps!
@@DietitiansinNutritionSupport thank you
You really have valuable content , i hope you make a return soon
Hi, I have a question. I just started working in a sub acute facility. Occasionally they have Residents who require tpn. They only use premixed formulas, and have to use whatever the pharmacy has available. If they ask me to write a tpn order, I can’t write it up until I know what formula is available, is that correct? From what I understand, they’re all different as far as kcal/pro/lipids etc. I can’t figure out the rate until I know which formula is available. I’m just making sure I understand how orders work for premixed formulas.
Hello! If you are working with premixed bags, do you have any consistency in what products are available through the pharmacy? In the experience of our team (we have about 3 regular premixed users we spoke with) there are often a set of products available to you to choose from like a 1000 kcal bag, 1500 kcal bag etc. For any premixed product, there should be published resources available for the product that offer rate tables and associated macronutrients that you can use to find an hourly rate that best matches the calorie and protein needs of your patient. In most cases, striving to meet protein goals becomes the priority as many premixed solutions will underfeed calorie wise. You may consider adding a lipid emulsion in as well to increase calorie provisions.
If you do not know at all what formula is available until literally the day you order it (this is a little unusual, but in times of product shortages anything can happen), then you would need to determine patient goals, figure out what product options you have, and then determine rate from there. Hopefully that helps and thanks for your question!
Thank you for the video! I do have a question for client 3. When we are giving try bags of 2 in 1 and 1 bag of lipids, do we also add extra micronutrients? The comparison of bag C to double bag D are way different.
Hi and thanks for your question! Generally, if we anticipate someone needs more micronutrients beyond what they are receiving, we would likely want to provide that to them in addition to the bag.
From an electrolytes perspective, if we anticipated a person needing more than was contained in the premixed bag we could consider the addition of a rider for the electrolyte(s) of concern. If we thought the standard bag might come close to our estimate of needs, we could propose trialling just the bag alone and see how the labs go the next day.
Thinking about trace elements and other vitamins/minerals, you can always provide an IV multivitamin to ensure the patient is getting adequate quantities of those nutrients. Lastly, be sure the whole medical team is on board with the decision to provide additional micronutrients/electrolytes (Pharmacist, Nephrologist, & Primary Physician etc.). Hopefully that helps!
@@DietitiansinNutritionSupport It did help. Thank you so much.