Individualized TPN Therapy - Fairview Health Services
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DO YOU KNOW... The Oley Foundation is a national, non-profit organization that provides information, tools and support to consumers of home parenteral (IV) and enteral (tube-fed) nutrition. These services are free and also offered to caregivers and clinicians. Some services they provide include: a newsletter, a network of volunteers who run support groups and education (such as tips for traveling with parenteral or enteral nutrition). Their website can be accessed at www.foley.org. Fairview Home Infusion FHIghlights Individualized TPN Therapy Total parenteral nutrition (TPN) patients come with many different needs, goals and lifestyles. At Fairview Home Infusion, our multi-disciplinary nutrition team of registered dietitians, pharmacists, and nurses individualize TPN therapy for each patient to meet their many unique needs. Our dietitians assess calorie, protein and fluid needs. Our pharmacists routinely monitor serum electrolytes, weight trends, oral intake and other laboratory data to determine the need for formula, calorie, and fluid adjustments. Our nutrition staff also works with nurses to teach patients, their families and other care- givers to appropriately manage their therapy and meet their lifestyle needs. TPN formulas include the majority of required nutritional components: protein, carbohydrate, fat, electrolytes and vitamins. In addition, TPNs routinely include trace elements—selenium, chromium, copper, manganese, and zinc. These are usually provided via a commercially prepared product that contains standard amounts of all 5 elements. While this formulation adequately prevents trace element deficiencies for the majority of TPN patients in the short-term, it actually over-supplements some patients in the long-term and frequently falls short in the amount of trace elements needed in certain situations. For example, patients with diarrhea often need increased provisions of zinc. Conversely, patients with liver dysfunction have decreased requirements of the liver-metabolized trace metals, manganese and copper, because the serum levels of these two components can build up over time. FHI has a policy of periodically monitoring serum levels of trace elements and adjusting the TPN provisions. This usually requires adding the trace elements to the TPN formulation individually. While many TPN patients only receive therapy for a few weeks or less, there are many who require extended care. For these patients especially, routine reviews to evaluate changing nutritional needs and goals is essential to their health and well-being for months, years and sometimes the rest of their lives. Volume 2, Issue 1 February 2011 Meet FHI’s Nutrition Team Our FHI nutrition team has a combined 56 years of experience in providing nutrition support to approximately 350 patients. This multi- disciplinary team conducts ongoing patient monitoring; provides teaching and training for internal staff and external agencies; and consults with hospitals, clinics and referral sources. If you would like to consult with a member of our nutrition team, please call 612-672-2233 or 800-642- 8845. Cali Shoen, RD, CNSC, Clinical Dietitian, has been with FHI for seven years and certified in nutrition support for 16 years. She completes clinical assessments, consults with hospital dietitians on transition of care and assists pharmacists with initiation of TPN. Cali loves gardening, visits Amelia Island each March and recently adopted two kittens. Shelly Setten, RD, Casual Dietitian, has many years of experience as a clinical dietitian in a hospital setting. Michelle Schmidt, LPN, Enteral Coordinator, has been with FHI for five years and in her current position for one year. Michelle is the friendly voice who routinely calls our enteral patients to make sure they have all the supplies they need. Lori Krieger, RPh, BCNSP, Clinical Pharmacist, has 18 years of experience in nutrition support and recently received her Board Certified Nutrition Support Pharmacist credentials. She’s a member of ASPEN and the Oley Foundation and especially interested in nutrition education for both patients and homecare agencies. Sandy Christensen, RPh, Clinical Pharmacist, has 19 years of experience in home infusion nutrition support. Besides taking great care of our patients, she enjoys sailing, scrapbooking and cooking. Jodie Murray, PharmD, Clinical Pharmacist, has been with FHI for over a year and shares her time between the nutrition and BMT teams. She has an adorable golden retriever named Moose and loves to travel in the winter to more tropical locations. Jon Olson, Pharmacy Coordinator, has eight years of home infusion experience and speaks with patients daily to coordinate delivery of TPN and supplies. Jon loves music, sports and being with his family. From left to right: (back row) Jon Olson, Cali Shoen, Lori Krieger, (front row) Jodie Murray, Michelle Schmidt, Sandy Christensen. Activity Corner: True or False A PEG tube may be utilized for feedings within several hours of placement?
Transcript of Individualized TPN Therapy - Fairview Health Services
DO YOU KNOW...The Oley Foundation is a national, non-profit organization that provides information, tools and support to consumers of home parenteral (IV) and enteral (tube-fed) nutrition. These services are free and also offered to caregivers and clinicians. Some services they provide include: a newsletter, a network of volunteers who run support groups and education (such as tips for traveling with parenteral or enteral nutrition). Their website can be accessed at www.foley.org.
Fairview Home Infusion
FHIghlights
Individualized TPN TherapyTotal parenteral nutrition (TPN) patients come with many different needs, goals and lifestyles. At Fairview Home Infusion, our multi-disciplinary nutrition team of registered dietitians, pharmacists, and nurses individualize TPN therapy for each patient to meet their many unique needs. Our dietitians assess calorie, protein and fluid needs. Our pharmacists routinely monitor serum electrolytes, weight trends, oral intake and other laboratory data to determine the need for formula, calorie, and fluid adjustments. Our nutrition staff also works with nurses to teach patients, their families and other care-givers to appropriately manage their therapy and meet their lifestyle needs.
TPN formulas include the majority of required nutritional components: protein, carbohydrate, fat, electrolytes and vitamins. In addition, TPNs routinely include trace elements—selenium, chromium, copper, manganese, and zinc. These are usually provided via a commercially prepared product that contains standard amounts of all 5 elements. While this formulation adequately prevents trace element deficiencies for the majority of TPN patients in the short-term, it actually over-supplements some patients in the long-term and frequently falls short in the amount of trace elements needed in certain situations. For example, patients with diarrhea often need increased provisions of zinc. Conversely, patients with liver dysfunction have decreased requirements of the liver-metabolized trace metals, manganese and copper, because the serum levels of these two components can build up over time. FHI has a policy of periodically monitoring serum levels of trace elements and adjusting the TPN provisions. This usually requires adding the trace elements to the TPN formulation individually.
While many TPN patients only receive therapy for a few weeks or less, there are many who require extended care. For these patients especially, routine reviews to evaluate changing nutritional needs and goals is essential to their health and well-being for months, years and sometimes the rest of their lives.
Volume2,Issue1February2011
Meet FHI’s Nutrition TeamOur FHI nutrition team has a combined 56 years of experience in providing nutrition support to approximately 350 patients. This multi-disciplinary team conducts ongoing patient monitoring; provides teaching and training for internal staff and external agencies; and consults with hospitals, clinics and referral sources. If you would like to consult with a member of our nutrition team, please call 612-672-2233 or 800-642-8845.
CaliShoen,RD,CNSC,ClinicalDietitian, has been with FHI for seven years and certified in nutrition support for 16 years. She completes clinical assessments, consults with hospital dietitians on transition of care and assists pharmacists with initiation of TPN. Cali loves gardening, visits Amelia Island each March and recently adopted two kittens.
ShellySetten,RD,CasualDietitian, has many years of experience as a clinical dietitian in a hospital setting.
MichelleSchmidt,LPN,EnteralCoordinator, has been with FHI for five years and in her current position for one year. Michelle is the friendly voice who routinely calls our enteral patients to make sure they have all the supplies they need.
LoriKrieger,RPh,BCNSP,ClinicalPharmacist, has 18 years of experience in nutrition support and recently received her Board Certified Nutrition Support Pharmacist credentials. She’s a member of ASPEN and the Oley Foundation and especially interested in nutrition education for both patients and homecare agencies.
SandyChristensen,RPh,ClinicalPharmacist, has 19 years of experience in home infusion nutrition support. Besides taking great care of our patients, she enjoys sailing, scrapbooking and cooking.
JodieMurray,PharmD,ClinicalPharmacist, has been with FHI for over a year and shares her time between the nutrition and BMT teams. She has an adorable golden retriever named Moose and loves to travel in the winter to more tropical locations.
JonOlson,PharmacyCoordinator, has eight years of home infusion experience and speaks with patients daily to coordinate delivery of TPN and supplies. Jon loves music, sports and being with his family.
From left to right: (back row) Jon Olson, Cali Shoen, Lori Krieger, (front row) Jodie Murray, Michelle Schmidt, Sandy Christensen.
Activity Corner: True or FalseA PEG tube may be utilized for feedings within several hours of placement?
Fairview Home Infusion711 Kasota Avenue, Minneapolis, MN 55414
Phone: 612-672-2234 ∙ Referrals: 612-672-7444fairviewhomeinfusion.org
Fairview Home InfusionNurse Training
Basic Infusion Therapy for NursesThis comprehensive, full-day course is offered at no charge to nurses of home health agencies who work with Fairview Home Infusion. Learn and review the basics of IV therapy as provided by Fairview Home Infusion, including: care and maintenance of infusion access devices, administration methods, protocols and equipment specific to FHI and anti-infective therapy and home parenteral nutrition.
2011CourseScheduleApril 21, 2011, 8:00 a.m. – 4:30 p.m.July 21, 2011, 8:00 a.m. – 4:30 p.m.October 20, 2011, 8:00 a.m. – 4:30 p.m.
CEUContactHours9 nursing Continuation Education Units.
Infusion Therapy Review for NursesThis half-day course is offered at no charge to nurses of home health agencies who work with Fairview Home Infusion. The review class is designed for nurses who have already taken the Basic Infusion Therapy course and includes the following: review of infusion access devices, infusion therapy infection control and fluid and electrolyte review.
2011CourseScheduleMay 5, 2011, 9:00 a.m. – 12:30 p.m.August 4, 2011, 9:00 a.m. – 12:30 p.m.November 3, 2011, 9:00 a.m. – 12:30 p.m.
CEUContactHours3.9 nursing Continuation Education Units.
RegistrationCall 612-672-5396 or use the online registration form at www.fairviewhomeinfusion.org.
LocationFairview Pharmacy Services711 Kasota Ave SE, Minneapolis, MN 55414Conference Room C*Lunch is provided for full-day classes
Questions?Call Karen Dziak, course coordinator, at 612-672-5396.
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Care and Maintenance of Enteral Feeding Tubes
Maintaining feeding tube patency is imperative for providing adequate calories, protein and fluid to patients who are unable to meet nutritional needs orally. Interruptions in an enteral regimen, due to tube occlusion, can result in weight loss, loss of lean body mass, dehydration and a potentially compromised response to medical therapy because of inadequate nutrition and hydration.
The single most effective measure in preventing clogs is to flush tubes adequately, and before and after medication administration. Water is the preferred flush solution, as it is inexpensive and available. Studies have indicated that water is superior to cranberry juice and carbonated beverages, which are both acidic and can actually coagulate the protein in the enteral formula and exacerbate clogs.
The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends
flushing tubes with 30 ml of water every four hours for adult patients on continuous feeds, and before and after intermittent feeds. For pediatric patients, the smallest volume needed to clear the tube should be used.
Adherence to flushing protocols for administering medications via feeding tubes is also recommended by ASPEN. The UMMC Nursing Policy for medication administration via feeding tubes states:
Flush feeding tube with 15-30 ml water before medication administration (5-10 ml for pediatric patients).Administer each medication separately and flush with at least 5 ml of water between each medication (3 ml for pediatric patients).Flush feeding tube with 15-30 ml water after medication administration (5-10 ml for pediatric patients).
Tablets should be ground to a fine powder and mixed well with 15-30 ml water for adults (5-10 ml for peds) prior to administration. Special instructions include:
Medications should not be added directly to the enteral formula. Liquid dosage forms should be used when possible. Some medications do not mix or are incompatible with enteral formulas. Enteric-coated products or sustained/extended release products should not be crushed. For additional information, refer to the manufacturer’s guidelines or consult a pharmacist.
If a clog does occur, irrigate the feeding tube with a 5 ml syringe of warm water with gentle pressure and a pulsing motion for 60 seconds. This may have to be repeated several times, but it should clear most occlusions.
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Activity Corner: AnswerTrue.Current literature supports within two hours in adults and six hours in infants/children. Post-operative patients that had enteral feedings initiated 24–48 hours after surgery demonstrated improved healing, shorter hospital stays and no difference in complications.
