Parenteral Nutrition in the Home and Alternate Sites Most patients prefer to cycle their PN overnight and have freedom


from the pump during the day. The major drawback to a nocturnal infu- sion is frequent urination due to the large volume of fluid being infused, which may interrupt sleep patterns. Therefore, some patients may prefer to infuse during the day. Patients who are more acutely ill and who are discharged to an alter-


nate site may be kept on a continuous infusion because of a tenuous fluid status in which a large amount of fluid infused over a shorter period is not tolerated. Before cycling PN, each patient should be receiving an appropriate


HPN formula that meets energy, protein, fluid, and electrolyte require- ments. Cycling is best done over 2 to 4 days by reducing a 24-hour infu- sion in increments of 4 to 6 hours at a time (eg, from 24–20 to 16–12 hours or from 24–18 to 12 hours). Certain patients may tolerate cycling from 24 hours to 12 hours in 1 day.21


of infusion is increased to ensure that nutrition needs are met. Some patients may only be able to be partially cycled (eg, 16 or 20 hours) due to volume limits or hyperglycemia.21


Glucose Stabilization and Monitoring


Some patients will develop hyperglycemia during the PN cycle because of the large amount of dextrose infused over a short period of time. Diabe- tes, corticosteroid use, and age are factors that increase the likelihood of requiring insulin during HPN therapy.22


Blood glucose can be controlled


by decreasing the dextrose content and increasing the lipid content, adding insulin to the PN formula, or lengthening the infusion period.23 Monitoring blood glucose to manage hyperglycemia while establishing the PN cycle can be done with a capillary blood glucose reading (finger stick) and use of a regular insulin sliding scale. Capillary blood glucose readings can be obtained during the cycle period as follows23


:


ƒ 1 to 2 hours after starting PN ƒ Mid-cycle ƒ 1 hour after stopping PN ƒ If hypoglycemic symptoms are present ƒ More frequently to determine management of uncontrolled glucose


Insulin is commonly added to the HPN to achieve glucose control,


with 0.05 to 0.1 units of regular human insulin per gram of dextrose recommended. Insulin may be increased as needed for optimal glucose management.11,23


Insulin added to the HPN formula has the benefits of 95


As infusion time is decreased, the rate


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149