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How many steps are in a PN recipe and what do you need to have prior to determine a PN recipe?
- There are 10 steps
- You need to have calcuated energy needs, protein needs, and fluid needs (if not given)
What is the first step in the PN Rx?
Determine total volume and infusion rate
Fluid need = kg x 30-35 cc/hr (can do 30 cc/hr with this)
Infusion rate ex: 1890 ml/24 hrs = 79 ml = 80 ml/hr (round!)
Total fluid need ex: 80 ml x 24 hrs = 1896 ml/day
What do you do after determing the fluid volume (2 step)?
determine calories from fat
20-30% kcal from fat
ex: 1476 kcal (from patient tee) x 25% kcal lipid = 369 kcal from fat
What comes after determing fat kcal (3rd step)?
Choose from the 4 options for lipid bags
- Either: 250 ml of 10% (250 kcal)
- 250 ml of 20% (500 kcal)
- 500 ml of 10% (500 kcal)
- 500 ml of 20% ( 1000kcal)
Ex: we choose 500 ml of 10% lipid to provide 500 kcal
What comes after determining the lipid bag option (4th step)?
determine remaining calorie and fluid needs
ex kcals: 1476 kcal- 500 kcal fat = 976 kcal
fluid: 1896 total ml- 500 ml from fat = 1396 ml
what comes after determining the remaining kcal +fluid needs (step 5)?
AA % concentration to meet protein need
ex: (44 g total /1396ml remain fluid) x 100 = 3.15 = 3% (dont forget to round)
What comes after determing the AA % conc.? (step 6)
determine calories from protein
ex: 3 % aa x 1396 ml remaining = 42 g aa
42 g aa x 4 kcal/kg (std amt)= 168 kcal
What comes after determining the protein kcal (step 7)?
Determine % CHO/dextrose from remaining kcal
ex remaining: 1476 kcal (total)- 500 kcal fat- 168 kcal pro = 808 kcal
ex: 808 kcal remain/ 1396 remain fluid = 238 g CHO
ex: (238 g CHO/ 1396 ml remain) x 100 = 17 = 15% dextrose
What comes after determining the CHO (step 8)?
Determine kcal from dextrose
ex: 15% dextrose x 1396 ml = 209 g CHO
ex: 209 g CHO x 3.4 kcal/g = 711 kcal
What comes after determing the kcal from CHO (step 9)?
Perform a values check
ex: 80 ml/hr of 15% CHO, 3% aa, 500 ml of 10% from fat
Yields 500 kcal from fat + 168 kcal pro + 808 kcal CHO= 1476 kcal total
- 808 kcal CHO / 1476 total kcal = 55 % cal from CHO
- 168 kcal pro/ 1476 total kcal = 11% cal from pro
- 500 kcal pro/ 1476 total kcal = 34% cal from fat
What comes after checking the values? (step 9 continued)
Check FIR and GIR
- ex GIR: (goal less than 5 mg/kg/min)
- 209000 g CHO/ 55 kg = 3800 g CHO/kg
3800 g CHO/kg / 1440 min = 2.64 g/kg/min
- ex FIR: (goal less than 2 mg/kg/min)
- 500 ml x 10% = 50g fat/ 55kg = 0.91 g/kg/min
What is the final step of the PN recipe?
The nutrition prescription
ex: no electrolyte of vitamin/mineral abnormalities identified, standard doses ok at this time
ex: Initiate TPN with D 15%, AA 3% at 30 ml/hr advancing by 25 ml/hr every 12 hrs to get to goal rate of 80 ml/hr.
Administr 500 ml of 10% lipid at 20 ml/hr
Yields 1896 ml total fluid, 1476 total kcal, 44 g protein, 209 g CHO, 50 g fat,
Include MVI and MTE