The intensive care patients as this allows for slower delivery and minimal gastric distention.Ĭ) When initiating tube feeds in the PICU please use the Gastric feeding protocol unless Gastric emptying, (duodenal trophic feeding can be initiated even in the absence of bowel sounds).ī) Continuous delivery tube feedings are usually tolerated better that bolus feeding in Feeding tubes may be placed in the stomach when the risk of aspiration or reflux isĪ) Transpyloric feeding tubes can be if there is altered G.I. I) ml of fat/day = total grams of fat/day * 5 ml/gmġ. may increase to maximum of 3gm/kg/dayĪ) Calculate Calories: (25‐30% of total calories) There are 20 gms of lipid per 100 ml of Lipids: use the 20% solution at 0.5‐1gm/kg/day. Ii) kcal AA/day = gm/day AA * 4.3 kcal/gmĤ. renal or liverĭisease, inborn error of metabolism.etc.). ![]() Reach the goal unless contraindicated by alterations in protein metabolism, (ie. Amino Acids: Start at 1 gram protein/kg/day and advance by 0.5‐1 gm /kg/day until you (2) Kcals from dextrose = grams of dextrose * 3.4 kcal/gmģ. (1) grams of dextrose = total volume of TPN * Dextrose % I) GIR = dextrose (gm/ml) x 1000 (mg/gm) x infusion rate (ml/hour)Ī) Increase by 20‐50%/day until at goal of total kcalī) Should be up to 60‐70% of total caloriesĬ) Excessive dextrose associated with fatty liver and increased VCO2 Carbohydrates: GIR (glucose infusion rate) is the milligrams of dextrose delivered per (Refer to TPN sheets for monitoring)Ī) Renal panel, Magnesium and Triglyceride should be checked daily until the patient is onī) Blood sugars should be followed closely when on high GIR’s especially when weaning offĢ. ![]() Total needs and blood chemistry levels largely determine tolerance to parenteral ![]() Reserved to patients in which enteral nutrition is contraindicated.ġ. Basically, in general, starting TPN later is preferable based on the available evidence. Timing: Fivez et al, NEJM 2016, found in a RCT of 1440 PICU patients, improved clinical outcomes (shorter ICU stay (6.5 vs 9.2 days), less new infections (10.7 vs 18.5%), shorter hospital stay, less renal replacement therapy, and shorter duration of mechanical ventilation in patients started "late" (day 8 of ICU stay) vs early (within 24 hours of PICU admission).
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