Access Devices and PN Concentrations

PN is administered into the venous system either through peripheral venous lines or through centrally placed access devices. Lower concentrations of dextrose and amino acids may be administered through peripheral veins for a short duration of therapy. Such formulas usually do not provide the patient's full nutrition needs, may require large volumes of fluid, and can only be used for short durations due to the difficulty of maintaining peripheral intravenous access. Osmolarity of peripheral formulas is best maintained at approximately 600mOsm/l or less. This requirement means that peripheral PN formulas should contain no more than 5-10% dextrose and 3.5-5% amino acids. Potential complications of peripheral PN include phlebitis, infiltration, or fluid-overload issues. When higher concentrations of dextrose and amino acids are used, such as those generally needed to provide adequate daily nutrient requirements via PN, the hyperosmolar formula must be administered

Table 4 Contents of a common parenteral trace element preparation

Component

Dose

Zinc

5mg

Copper

1 mg

Manganese

0.5 mg

Chromium

10 mg

Selenium

60 mg

directly into the superior or inferior vena cava to facilitate rapid dilution. Commonly used central venous catheters that may be used to administer PN include subclavian vein catheters, peripherally inserted central catheters, subcutaneously tunneled percutaneous catheters, or implanted subcutaneous infusion ports. Catheter type will be determined by expected duration of need, specific patient condition, patient care setting, as well as physician or patient preference.

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