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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Nutrition

Parenteral Nutrition: Parenteral Nutrition (608)

Parenteral Nutrition: Parenteral Nutrition (608) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Nutrition

608


Parenteral Nutrition

What is parenteral nutrition (PN)?
Parenteral nutrition (PN) is nutrition that is
given through an IV. The PN bag contains
protein, carbohydrate (sugars), fat (lipids),
vitamins, minerals, electrolytes (such as
sodium, potassium, magnesium) and
water. These nutrients in the PN go directly
into the bloodstream.

Why do I need PN?
You may need PN when you are not able to
eat, or when your body cannot digest food as
it should. You may need PN if it is not safe
for you to eat food by mouth or receive tube
feeds. You may need PN if you have short
gut syndrome, perforations or leakages in
the bowel, bowel obstruction as well as
other conditions.

Why is nutrition important?
Good nutrition is needed for strength,
energy, and maintaining a healthy body
weight with muscle. The body cannot heal
and recover without good nutrition.

How will I receive PN?
An IV catheter is placed in a large vein
through the arm or chest. PN is given
through this IV catheter. The catheter can
stay in for as long as needed. Proper care is
required to avoid problems such as infection
or clotting. PN can be given all throughout
the day or sometimes over a shorter period
of time such as 12, 14 or 16 hours.

In rare cases, if you are waiting for a
catheter to be placed in a large vein, a dilute
form of PN may be given through an IV
catheter placed in a small vein for a short
time.



How long will I receive PN?
The length of time you need PN may vary.
You will need PN until you can start eating
food again, and your body is able to digest
the food and absorb the nutrients. Your
doctor can also stop PN if you can be fed
through a feeding tube placed in the stomach
or small bowels.

What is the difference between enteral
feeding and PN?
Enteral nutrition (EN), also called tube
feeding, is a way of giving nutrition through
a feeding tube. The tip of the tube is placed
either in the stomach or in the small bowel.
The body can digest and absorb the nutrients
once EN is placed in the stomach or bowels.
PN goes directly into the bloodstream and
will bypass the stomach and bowels.

What are the side effects or problems
with PN?
There are some side effects or complications
that may occur with PN. These include:
ξ Risk of infection
ξ High blood sugar
ξ High triglycerides.
ξ Fluid and electrolyte imbalance

Your healthcare team will closely watch
your PN therapy to avoid, or lessen the risk
of these side effects. If you have side
effects, your healthcare team will treat these
problems.

What happens when I go home with PN?
Not all patients need PN when they leave the
hospital. If you will need PN at home, your
healthcare team will create a safe plan for
you. At home, most patients will have their
PN running only 12 or 14 hours overnight,

so they don’t have to be hooked up to the IV
all day.

Home PN will be brought directly to your
home by a home infusion company. Your
provider will watch your progress and adjust
your home PN as needed.

A nurse will come to your home about once
a week to check your progress and to get
blood samples which are used to monitor
your PN therapy.

Training and support
At home, your provider will teach you and
your caregivers about PN therapy. You will
be given written and verbal instructions on
your home PN therapy. You will also be
taught how to take care of your catheter,
change dressings and set up your PN.

How do I get supplies and equipment?
Supplies will likely be brought to your home
by a home infusion company. Every week,
a provider from the home infusion company
will call you to ask what supplies you need
for the next week.

How do I get my home PN?
A weekly batch of PN will be given to you
by the home infusion company.

How do I store PN?
PN bags should be stored in a fridge. Check
the labels on the additives and store per
those instructions.
ξ PN bags can be warmed at room
temperature for at least 2 hours
ξ Do not infuse PN bags or additives
if they have not been stored the right
way
ξ Do not infuse PN bags that have
particles or look cloudy at room
temperature (this is for PN bags that
have no fat or lipid added)
ξ Do not infuse PN bags with fat or
lipids if you see an oily layer
ξ Do not hold PN bags under water to
warm. Tap water in sinks or
containers are not sterile and will
contaminate PN bag and injection
ports
ξ Do not place PN bags in the
microwave, on heaters or in direct
sunlight
ξ Do not leave PN bags at room
temperature for longer than 24 hours
ξ Do not use PN bags if it has been
spiked with tubing for more than 24
hours

What do I need to monitor?
ξ Monitor your weight daily. Take
your weight at the same time each
day. Wear similar clothing. Use the
same scale. Call your doctor if you
gain 2 pounds or more in one day or
gain 5 pounds or more in one week.
ξ Take your temperature daily.
Take your temperature at the same
time every day. Check your
temperature any time you are feeling
ill, have the chills or feel hot. Call
your doctor if you have a
temperature greater than 100˚F or 1
degree greater than your usual
temperature.
ξ Monitor your intake and output daily
on the record provided at the end of
this handout. Keep track of drainage
from an ostomy, fistula, wound or
from other drainage tubes. Call your
doctor if there are any changes.
ξ Monitor your blood glucose as
instructed by your doctor. Look for
signs of hypoglycemia or
hyperglycemia.




When do I need to contact my PN provider?
Problem Action patient should take
Catheter breaks, cracks or leaks Clamp catheter above problem area
Call home PN provider to arrange for repairs
Catheter has withdrawal
Infusion occlusion
Call home PN provider to restore the catheter
Fever
Chills with PN infusion
Stop PN right away
Call home PN provider or go to emergency
room
Drainage, pus, tenderness or
redness at catheter exit site or along
catheter tract
Call home PN provider for proper treatment
Chest pain, shortness of breath or
loss of consciousness
Clamp catheter
Call 911
Lie on left side
Pump malfunction Check electrical source
Call home PN provider for repair or
replacement
Elevated urine or blood glucose Call home PN provider to adjust PN infusion
rate or insulin
Low blood glucose with sweating,
headache, shakiness, blurred vision
If you can safely take fluids by mouth, drink
juice, regular soda (not diet) or sugar water
If you are not able to take fluids by mouth, take
hard candy or glucose gel
Call home PN provider to adjust PN infusion
rate or insulin.
More thirst, low urine output,
increased ostomy output or muscle
cramps
Call home PN provider with intake / output
record and
Home PN provider will adjust PN fluids
Rapid weight gain, swelling of
hands, feet, ankles, or short of
breath
Call home PN provider to adjust PN fluids












Daily Intake and Output Record
Date
Weight
Goal Weight
Temperature (F)

INTAKE (mL)
Oral fluid
PN
IV fluid

URINE OUTPUT (mL)
Urine
Stoma

OTHER OUTPUT (mL)
(circle)

GT JT PEG
Drain Fistula
Vomiting Diarrhea

TOTAL OUTPUT

GLUCOSE (circle)
Finger
stick (acu-
check)
Urine