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Coeliac diagnosis pathway (Adults)
Sengstaken/Minnesota Tube for Bleeding Varices
Eradication of Helicobacter pylori
Acute Severe Ulcerative Colitis
Acute Upper GI Bleeding (AUGIB)
Iron Deficiency Anaemia
Dyspepsia
Nutritional Support in Adults
Refeeding Syndrome
Parenteral Nutrition
Crohn’s Disease
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Parenteral Nutrition
Last updated 3rd December 2020
Introduction
- Should be considered when not possible to meet estimated nutritional requirements enterally.
Indications for PN
- Anastomotic breakdown following intestinal resection
- Small bowel obstruction
- Ileus
- Major gastrointestinal surgery
- Acute exacerbation of Inflammatory Bowel Disease
- Fistula
- Short bowel syndrome
- PN may also be used if there is a problem in Enteral Nutrition(EN) being established ie if the patients is not absorbing feed
PN Regimens Available at DGRI
- There are currently 4 options available at DGRI as follows:
*Nutriflex Lipid Peri 1250ml is the product used as an Emergency Regime and is the starter PN feed of choice
Starting PN
- Contact Dietitian (33568) to calculate nutritional requirements.
- Alert ward Pharmacist and send PN prescription to Pharmacy BEFORE MIDDAY Monday to Friday.
- PN bag will be delivered to ward by 5pm
- Usually start by giving 10kcal/kg to reduce risk Refeeding syndrome
- All TPN bags can be infused over a maximum of 24 hours.
Vitamins and Minerals
- Separate infusion can be prepared at ward level
- Add 10ml Additrace to 100ml NaCl 0.9% or Dextrose 5%.
- Withdraw 10ml of Vitilipid and reconstitute one vial of Solivito N, then add reconstituted Vitilipid/Solivito to the same infusion bag.
- Mix well, protect infusion from light and infuse over 2-3 hours.
Monitoring During PN
- U&E, LFTs, Ca, Mg, PO4, CRP baseline and daily – easiest if you write ‘TPN monitoring’ on biochem request form
- Correct electrolytes before starting PN – Pharmacy can advise.
- Monitor blood glucose 4-6 hourly.
- Baseline weight where possible then weekly thereafter.
- Monitor fluid balance – may need to adjust background fluids
Route
- Must be dedicated line
- Some regimens suitable for peripheral administration
- All regimens suitable for central administration