PPN is good for 2 weeks only due to risk of phlebitis and thrombosis. Usually 1500-1700 kcal is okay but it can load >2 liters to lessen the osmolarity. Therefore, Central line PN is well tolerated even higher calories, either higher volume or low volume or fluid restricted.
Hi there, you are absolutely correct! That is a mistake in our math, thank you for bringing it to our attention. We've made a note in the video description about this error.
Hi! Thank you for this film. Your calculation is seperate for all cations, but then how about vitamins and minerals? Is amount of osmolarity added from ex. Soluvit/Vitalipid and Addamel so insignificant that you didn't metion abou it? Thank you for an answer it's really important for me. I would be grateful if you could show the source of this informations.
Great question! The electrolytes included in the calculation here (sodium, potassium, calcium and magnesium) are most of your major minerals and encompass much of the mineral provisions. Other minerals (trace or ultra-trace) will be provided in much lower quantities and are not always consistently given in daily PN bags and thus do not contribute heavily to osmolarity. Similarly, vitamins are offered in much lower quantities. Looking at a product like Vitalipid for adults, this product is approximately 300 mOsm/kg water (or 300 mOsm/L water), and typical dosage is 10 mL/day. You can find this information by looking at the product guide for Vitalipid or any other commercial infusion product. Looking at some math here we could calculate a contributing osmolarity of: 10 mL/day * 300 mOsm/1000 mL = 3 mOsm / 1 day provision You are certainly welcome to add in this osmolarity to your own calculations, but as this is quite a small contribution, we omitted this in ours. Other things to note, the PN compounder in your institution will be able to provide total osmolarity for the bag being infused based on the exact content, and most all commercial PN products state total osmolarity on the bag if you are using pre-mixed. Hope that helps!
@@DietitiansinNutritionSupport so in case of Addamel (3100 mOsm/kg water) the typical dosage is 10mL and in the end i should add to 895mOsm/l (like in your example) 31 mOsm? so the final number will be 926 mOsm/L?
Great question! From online calculators I also feel it is typical for them to omit lipid osmolarity, with some peer reviewed articles even noting they don't believe lipid to contribute to osmolarity. Lipids do actually provide osmolarity to the solution, just not as significantly as AAs or dextrose. If you're interested, you can look further at specific lipid product labels that will often note osmolarity or talk to a pharmacist/compounder at your facility.
Question. According to your example the pt would be receiving 720kcal/L. Let’s say the pts needs are around 2000kcal/day. Can the pt receive 3L over the course of 24hrs to meet their needs? If that is so why then is it so difficult to meet needs for a pt without fluid restriction?
Great question! We talked with a pharmacist to help with this question (thanks Leslie!). For PPN, you can in theory provide any volume of fluid over a 24 hour period, that being said, there is likely a higher risk for infiltration. Risk for infiltration is primarily based on 2 components, osmolarity and rate of infusion. Because PPNs are infused peripheral, national recommendations state to keep the osmolarity < 900 mOsm. Then looking at rate of infusion, when we consider a higher infusion volume (> 2L), we would have to increase our rate of infusion to provide that solution in the 24 hour time period. While this is technically possible, the reason that folks tend not to utilize more than 2 liters is because the rate of infiltration increases as the rate of the infusion increases. A 2L bag will infuse at 83 mL/hr while a 3L bag would have to infuse at 125 mL/hr and this increases the risk for infiltration and phlebitis. With the increased risk for infiltration and phlebitis occurring with high volume PPN, and furthermore, PPN’s typical usage as a short term supplementation until enteral nutrition can be maximized, it may not be the most appropriate choice to pursue this kind of recommendation. Should someone be malnourished or needing long term PN, it is likely most beneficial to seek central access for PN.
Thank you for the thorough answer! For those who were unsure what infiltration meant as I was. IV infiltration is when the catheter dislocates or migrates out of the vein thus dumping its contents into the surrounding tissues. Depending on what was being administered this can cause tissue damage and necrosis.
Thank you so much. It's a very nice video. It has Informative information about PPN
PPN is good for 2 weeks only due to risk of phlebitis and thrombosis. Usually 1500-1700 kcal is okay but it can load >2 liters to lessen the osmolarity.
Therefore, Central line PN is well tolerated even higher calories, either higher volume or low volume or fluid restricted.
I forgot how to calculate PPN but thanks!!!! Great video! I wish we could implement this in psych
Thanks once again the result is 885 mOsm / L, not 895 mOsm / L
Is there a comprehensive general guideline concerning Peripheral Parenteral Nutrition (PPN) with great Thanks.
Thanks , the video was helpful
Can you explain where the extra 10mosm/L came from? I got 500+200+45+140 = 885mosm/L.
Hi there, you are absolutely correct! That is a mistake in our math, thank you for bringing it to our attention. We've made a note in the video description about this error.
Hi! Thank you for this film. Your calculation is seperate for all cations, but then how about vitamins and minerals? Is amount of osmolarity added from ex. Soluvit/Vitalipid and Addamel so insignificant that you didn't metion abou it? Thank you for an answer it's really important for me.
I would be grateful if you could show the source of this informations.
Great question! The electrolytes included in the calculation here (sodium, potassium, calcium and magnesium) are most of your major minerals and encompass much of the mineral provisions. Other minerals (trace or ultra-trace) will be provided in much lower quantities and are not always consistently given in daily PN bags and thus do not contribute heavily to osmolarity. Similarly, vitamins are offered in much lower quantities. Looking at a product like Vitalipid for adults, this product is approximately 300 mOsm/kg water (or 300 mOsm/L water), and typical dosage is 10 mL/day. You can find this information by looking at the product guide for Vitalipid or any other commercial infusion product.
Looking at some math here we could calculate a contributing osmolarity of:
10 mL/day * 300 mOsm/1000 mL = 3 mOsm / 1 day provision
You are certainly welcome to add in this osmolarity to your own calculations, but as this is quite a small contribution, we omitted this in ours. Other things to note, the PN compounder in your institution will be able to provide total osmolarity for the bag being infused based on the exact content, and most all commercial PN products state total osmolarity on the bag if you are using pre-mixed. Hope that helps!
@@DietitiansinNutritionSupport so in case of Addamel (3100 mOsm/kg water) the typical dosage is 10mL and in the end i should add to 895mOsm/l (like in your example) 31 mOsm? so the final number will be 926 mOsm/L?
@@ewas7553 Yes! Hopefully that helps with future osmolarity calculations :)
I've seen some calculations for osmolarity omit the calculation for lipids. Why is it included here?
Great question! From online calculators I also feel it is typical for them to omit lipid osmolarity, with some peer reviewed articles even noting they don't believe lipid to contribute to osmolarity. Lipids do actually provide osmolarity to the solution, just not as significantly as AAs or dextrose.
If you're interested, you can look further at specific lipid product labels that will often note osmolarity or talk to a pharmacist/compounder at your facility.
Question. According to your example the pt would be receiving 720kcal/L. Let’s say the pts needs are around 2000kcal/day. Can the pt receive 3L over the course of 24hrs to meet their needs? If that is so why then is it so difficult to meet needs for a pt without fluid restriction?
Great question! We talked with a pharmacist to help with this question (thanks Leslie!). For PPN, you can in theory provide any volume of fluid over a 24 hour period, that being said, there is likely a higher risk for infiltration. Risk for infiltration is primarily based on 2 components, osmolarity and rate of infusion. Because PPNs are infused peripheral, national recommendations state to keep the osmolarity < 900 mOsm. Then looking at rate of infusion, when we consider a higher infusion volume (> 2L), we would have to increase our rate of infusion to provide that solution in the 24 hour time period. While this is technically possible, the reason that folks tend not to utilize more than 2 liters is because the rate of infiltration increases as the rate of the infusion increases. A 2L bag will infuse at 83 mL/hr while a 3L bag would have to infuse at 125 mL/hr and this increases the risk for infiltration and phlebitis.
With the increased risk for infiltration and phlebitis occurring with high volume PPN, and furthermore, PPN’s typical usage as a short term supplementation until enteral nutrition can be maximized, it may not be the most appropriate choice to pursue this kind of recommendation.
Should someone be malnourished or needing long term PN, it is likely most beneficial to seek central access for PN.
Thank you for the thorough answer! For those who were unsure what infiltration meant as I was. IV infiltration is when the catheter dislocates or migrates out of the vein thus dumping its contents into the surrounding tissues. Depending on what was being administered this can cause tissue damage and necrosis.
Miller Sarah Martinez William Thompson Patricia
thank you, it really helpful
Brown Paul Clark Nancy Johnson Jose
Young Lisa Garcia Charles Walker Steven