A 65 year old male with a small bowel obstruction is to be started on TPN. He is 5’ 9” and weighs 70 kg. The patient develops severe ileus post op. He is being started on TPN. The TPN bag is running at 85ml/hr providing 300 g dextrose and 110 g protein. Lipids are piggy-backed at 250ml/day of 20% lipids. What is the total kcals he is receiving from the TPN bag?
Hi all! I work with a NP who insists on flushing enteral tubes with gatorade for any patient with a low sodium. There is literally a bag filled with fruit punch gatorade hanging on the pole to be used as a flush. She refuses to use saline because she says it causes diarrhea. I know this is not best practice or evidence based but she insists it is. There are no ASPEN guidelines regarding this and
Is there a recommendation for flushes with J tubes? Ive always done their extra water needs divided by the number of hours on TF. So if a person was to be on tubefeeding at night for 12 hours, then I would do the formula at 100ml/hr x 12 hours at night + flushes at 75ml q1h x 12 hours. however I have co-workers that prefer to do the flushes at like 150ml q4h with that same TF. Ive always thought
I am a 69-year-old male. I have Muscular Dystrophy. I have not stood up for twelve years. I am in a power wheelchair. I am on a LVT 950 respiratory ventilator. I recently had a PEG tube installed because I cannot swallow safely.
Today I started self-administering Nutren Pulmonary 1.5. It says it is a complete nutrition.
Do I need to add fiber and water to my diet or is the Nutren en
Has anyone ever heard of using baby rice cereal through a gtube to help with diarrhea? Some people at my facility have used it in the past but I can't find any information on it. I don't want to recommend it without having some insight first...thanks!
Hi all, I'm having a hard time finding a consistent definition of hemodynamic stability. I've seen several different criteria used: MAP >65 for >24 hours, normal BP with stable pressors, no pressors, etc. I end up delaying feeding for longer than I'd like because many of my patients don't reach "stability" until they've been in the ICU for several days. Specific parameters are appreciated!
I work in a long term care facility for the developmentally disabled. We recently got a new pediatric admission who is on powdered enteral formula. I am curious in other facilities, who prepares the formula for the patient? Nursing wants it to be done by the kitchen staff, but we don't feel that it should be their responsibility (concerned with sterilization and mixing the proper concentration).
CPN, Osmolarity, and Amino Acid Recommended "Upper Limits"
I am well aware of the limits posed by PPN on regarding osmolarity, amino acid, and dextrose concentration. However, I was just curious - does anyone have any evidence-based data on the "upper limit" or threshold for TPN/central PN for the following if such data exists):
Thanks for your help in advance!
I work in long-term care and have a patient who has been on enteral feeding for years. I've been at this particular facility for maybe 6 months and around the time I started here we struggled with him losing weight; eventually rectified with an elemental formula. He was stable for ~3 months, then 30 days ago he started to gain and gain each week, about 12 lb total. Then just as suddenly and witho
Patient has an NJ tube, 10 Fr. Kangaroo Joey feeding sets. The set is properly connected into NJ tube, but does not stay in place. The feeding sets easily disconnect from the NJ tube. Patient keeps "feeding the bed" and daytime mobility is limited due to disconnection. Feedback I get from clinicians is "that shouldn't happen" or "that is not common." It is happening and I need advice how so
Are there any RDs out there whose facility has adopted the Enhanced Recovery After Surgery protocol?
I am trying to find some pre-op CHO drinks available in the U.S. that would meet the protocol (CHO drink containing mostly maltodextrin, no protein or fat). So far no luck with Nestle or Abbott (Ensure clear etc. won't work as it is the wrong type of CHO and has protein/fat).
I am needing some clarity on figuring the rate for PPN's. Say a hospital has a standard formula - 4.25% dextrose, 5% AA and lipids 200 kcals/Liter.
It is a 3 in one mixture. I see these numbers but I need it broken down to figure the rate. Please someone help this math dunce out! Thanks!!
Has anyone heard of developing high trigs from long term EN?They are not scary high but they are creeping up (177) and lipase has been elevated for a while and getting higher and well. She has been on EN for 10 months with no other issues. BG looks great. On Perative 1.3 receiving 1170kcal/day.