TPN Clerkship 29/10/12 - 2/11/12

Total Parenteral Nutrition(TPN)

• What you may learn from TPN clerkship?
• We have done this clerkship on 29/10-2/11/2012.
• TPN is one of the department which provide nutrition in IV for those who have GI problem/dysfunction.

Clean Room

• What is clean room? - It is a space which is clean from any rubbish,dust and tidy.
• Our clean room need to have a negative pressure (to avoid any particle/dust trap into a preparation),Temperature should be 18-22 Celsius and particle count is less than 10,000 particles per meter .

Personal Protective Equipment(PPE)

Definition:

- Covers any item intended for wearing or carrying by the worker  

  with the aim of protecting him from one or more risks likely to 

  cause injury or jeopardize health while at work in addition to any 

  item or accessory having the same purpose.

1. GOWN         - clothing to prevent the wearer from injury.
2. OVERSHOE - Disposable,  lint free and low permeability fabric, also long enough to cover ankle cuffs.
3. MASK           - Offer protection against inhalation of powder
4. GLOVES       - Non-linting, long enough to cover wrist cuffs of the garment.Use a standard TPN gloves.
    

 

Calculation in TPN
i) Paedriatic 

MACONUTRIENT

• Paeds Factor (PF)

      PF = {[(Vol x Bw)+20]/[Vol x Bw]} x Bw

      *Vol = 150 ml/kg/day ( < 1 years old)

               = 80 - 120 ml/kg/day (1-2years old)

• Amino Acid

      Amount(g)  = Req. x PF

      Volume (ml) = Amount (g)  x  1000ml

                                                         65.3g

• Dextrose 50%

      Amount(g)  = Req. x PF

      Volume (ml) = Amount (g)  x  100ml

                                                         50g

• Lipid 20%

      Amount(g)  = Req. x PF

      Volume (ml) = Amount (g)  x  100ml

                                                         20g

MICRONUTRIENTS

• Water Soluble Multivitamin(Soluvit-N)

       Dose : 1mg/kg

       If > 10kg : 10ml ( 1 vial)

       Volume(ml) = Req. x PF

• Fat Soluble Vitamin( Vitalipid)

       If Bw < 2.5kg  =  4ml/kg

       If Bw > 2.5kg  =  1ml/kg(max 10ml)

• Trace Elements(Peditrace)

       Dose   :  1ml/kg

       If > 10kg : 10ml ( 1 vial)

       Volume(ml) = Req. x PF

ELECTROLYTES

• Phosphate

       Amount(mEq)  =  Req. x PF

       Sodium Glycerol Phosphate(Glycophos)

       Vol. (ml) = Amount (mEq)

                                   1

• Sodium

      Amount(mEq)  =  Req. x PF

      Sodium Acetate

      Vol. (ml) = Amount (mEq) - 2(amount Glycophos)

                                                       2

• Potassium

       Amount(mEq)  =  Req. x PF

       K Acetate

       Vol(ml)  =  Amount (mEq)

                                      2

• Magnesium

      Amount(mEq)  =  Req. x PF

      MgSO4

       Vol(ml)  =  Amount (mEq)

                                      4

• Calcium

        Amount(mEq)  =  Req. x PF

        Ca Gluconate

        Vol(ml)  =  Amount (mEq)

                                   0.45

OTHERS

• Total Vol. Req

       Volume(ml)  =  Req. x PF

• Vol of WFI need to add up

       Vol.(ml) = Total Volume Req. - Total[ (Macronutrients+Micronutrients+Electrolytes)ml]

• Vol. of TPN bag

       Vol.(ml) = Total Volume Req. - Total[ (Lipid+Lipid Soluble Vitamin)ml]

• [Amino Acid % (w/v)]