tnt session 6 revisi

7/24/2019 TNT Session 6 Revisi

http://slidepdf.com/reader/full/tnt-session-6-revisi 1/22

Central VenousCentral Venous

Catheters andCatheters andComplications ofComplications of

Parenteral NutritionParenteral Nutrition



Objectives

• To identify the appropriate methods of central venous

access for parenteral nutrition

• To describe catheter-related, metabolic, and GI

complications of parenteral nutrition

• To explain how to prevent catheter-related, metabolic

and GI complications of parenteral nutrition



Dierent type of Central Venous

Catheter

Hickman Catheters



Catheters for Central Venous

Access

• Choosing CVC, the insertion site, placementtechniue based on condition of patient and duration

of !"#• Temporary $% & wee's( or permanent $) & wee's(

• Various lengths, gauges, and number of ports $singlelumen more preferable than * or + lumens, to avoid

increase ris' of infection(

• Catheters treated with antibacterials

• Infusion via a dedicated catheter lumen



Temporary Subclavian Catheterduration of PN ! " #ee$s%

cCarthy C, et al# JPEN ./012*3.-*4*



Peripheral Central VenousCatheterP&CC ' Peripherally(&nserted(Central(

catheter

Garanows'i 5# J Intraven Nurs ..+14240-.&



Central Venous Access

In2 6rey 78, urray 95, eds# Dynamics of Nutritional Support # "orwal', CT2 :ppleton-Century-Crofts1p# +/*#

Vena subclavia

Vena cefálica

Catéter venosocentral

Vena cavasuperior

Yugular interna

Yugular externa

Vena axilar

Vena braquial

Vena basílica

Subclavian Vein

Cephalic Vein

Central Venous

Catheter

Superior

Vena Cava

Internal ugular

!xternal ugular

"xillar# Vein

$rachial Vein

$asilic Vein



Central Venous Access

• ;irst choice 2 subclavian vein

• 7econd choice 2 internal vein <ugular and external

=ugular vein#

• Third choice 2 cephalic and basilic vein

• 5ast choice 2 femoral vein



Permanent Central VenousAccess

• Tunneled subclavian catheter or Implantable infusion

port, reuires surgical procedure# >xit point located far

from airway# 9ecommended when !" ) & wee's



Subclavian Catheter Dressin)

?ressing should be changed using strict, aseptic

techniue every &/-0* hours



Conclusion in choosin) CVC

•Single lumen more preferable.

•First choice via subclavian vein.

•Dressing : 48-72 hours

•Very rarely permanent V



Parenteral Nutrition*

Complications

• Catheter-related

• etabolic• Gastrointestinal

9yan <:# Complications of total parenteral nutrition# In2 ;ischer <>, ed# Total Parenteral

Nutrition. 5ittle, @rown and Company1 .04




ComplicationsCatheter-related

• Insertion

A pneumothoraxA chylothorax

A hemothorax

A air embolus

A arterial punctureA nerve in=ury

?empsey ?T# Complications of total parenteral nutrition# In2 Torosian 9, ed#Nutrition for the Hospitalized Patient. "ew Bor'2 arcel ?e''er, ..3





• echanical complications

A poor catheter placement $malpositioned catheter,

3,3-33(

A phlebitis

A thrombosis

A catheter occlusionA rupture

A embolus

9yan <:# Complications of total parenteral nutrition. In2 ;ischer <>, ed# Total Parenteral

Nutrition. 5ittle, @rown and Company1 .04# :7!>" @oard of ?irectors# JPEN *DD*1*4 7uppl2+07:





• Infection

A catheter insertion siteA subcutaneous tunnel

A coloniEation

A bacteremia

A sepsis

6emp 5, et al# JPEN ..&1/20-0&

9eed C9# Intensive Care ed ..31*200-/+



+ospital(dependent ,is$ factors

Physician experienced

Duration catheterization

Number of lumens

Insertion sites

Use of maximum barrier protectionA surgical hand scrubbingA sterile clotting-long sleeved gown, cap, mas'(

A sterile gloves A wide sterile field

6emp 5, et al# JPEN ..&1/20-0&

9eed C9# Intensive Care ed ..31*200-/+




ComplicationsMetabolic

• 8yperglycemia $max rate dextrose infusion no greater than &-3mgF'gFminute(, hypercapnia

• 8ypoglycemia• Complication from lipid used $hypertriglyceridemia,

immunosuppression, lipid overload syndrome(

• >lectrolyte imbalance

• !rerenal aEotemia• :bnormal acid-base balance

• 9efeeding syndrome A measure !, g, 6, and glucose

?empsey ?T# Complications of total parenteral nutrition# In2 Torosian 9, ed# Nutrition for the

Hospitalized Patient # "B2 arcel ?e''er, Inc#1 ..31 7olomon 7# JPEN ..D1&2.D-.0




ComplicationsGastrointestinal

• 5iver function disorder, GI atrophy, gastritis and ulcer#

•GI atrophy associated with absence of2 luminalnutrient,mechanical stimulation of the gut, insufficientsupplies of primary enterocyte fuel source#

• GI atrophy begins to develop within &/ h of enteral fastingand maybe permissive for the bacterial translocation#

• Complication can be decreased by providing smallamounts of food enterally when possible and transitioningto tube or oral feeding as soon as possible#




ComplicationsOerfeedin!

:dministering more than +3 'calF'g results in2A hepatic steatosisA hyperglycemiaA prerenal aEotemiaA hypertriglyceridemia

A increased C*

productionA respiratory distress syndrome

?empsey ?T# In2 Torosian 8, ed# Nutrition for the Hospitalized Patient # "ew Bor'2 arcel

?e''er Inc#1 ..3



Summary* Appropriate Therapy

%arenteral nutrition is in&icate& 'hen(

• >nteral nutrition is contraindicated

• >nteral nutrition cannot be established or maintained

• ral or enteral nutrition does not satisfy all nutritional

reuirements

:spen @oard of ?irectors2 JPEN *DD*1*4 7uppl 2/7:-.7:



Summary* Access Devices forParenteral Nutrition

Parenteral nutrition catheters are selected based on"

• >xpected duration of therapy

• "umber of lumens needed

• Huality of peripheral vein access

Garanows'i 5# J Intraven Nurs ..+14240-.&



Summary* -onitorin)

Parenteral nutrition must be carefully monitored to"

• aintain electrolyte and acid-base balance

• >nsure that nutritional goals are met

• :void mechanical, metabolic, and GI complications

9yan <:# Complications of Total !arenteral "utrition# In2 ;ischer <>, ed# Total Parenteral

Nutrition. 5ittle, @rown and Company1 .04

tnt session 6 revisi

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