Ministry of health of Ukraine
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| Parenteral and enteral FEEDING CHILDREN
1. Background. In pediatric surgery often raises the question of the impossibility of feeding in the postoperative period and there is a need for parenteral nutrition (HRP) - providing the body with nutritious ingredients bypassing the gastrointestinal tract. In many evils and diseases of the HRP can get good outcomes of treatment and allow the child to recover. 2. Specific objectives: 1. Analyze the need for the appointment of parenteral nutrition (HRP). 2. Substantiate the indications for HRP. 3. Submit plan baseline examination before HRP. 4. Know the classification of essential drugs for HRP. 5. Interpret the advisability of a particular type HRP. 6. Analyze HRP. 7. Submit algorithm acts involving complications HRP and methods of prevention. 4.2. Theoretical questions to studies. 1. The concept of parenteral nutrition (HRP). 2. Indications of parenteral nutrition. 3. Putting drugs HRP through peripheral and central veins. 4. Conducting parenteral nutrition and infusion therapy. 5. The need for energy. 6. The need for glucose. 7. The need for insulin. 8. Need fats. 9. Protein requirements. 10. Preparations of amino acids. 11. Vitamins and minerals. 12. Algorithm HRP. 13. Complications HRP. TOPICS CONTENTS. Parenteral nutrition (Greek para - about + enteron - colon) - the body of nutritious ingredients (nutrients), bypassing the gastrointestinal tract. The quantity and quality of nutrients that enter meets such as in natural food. HRP used in mechanical obstacles in different parts of the gastrointestinal tract, functional impairment of the gastrointestinal tract complications during the postoperative period. Parenteral nutrition in children indicated: severe gastroenteritis, necrotizing enterocolitis, idiopathic diarrhea, toxic dyspepsia, impaired intestinal absorption syndromes, condition after surgery for intestinal obstruction, bowel resection with intestinal anastomosis overlapping, diffuse peritonitis, fistula of the small intestine, large burns body near postoperative period after all the heavy operations on the gastrointestinal tract, the inability of artificial enteral nutrition. Often full of HRP is the only method of feeding a child. Indications for early HRP in newborns: - Premature babies weighing less than 1.500 kg, which links enteral load and ynfuziynoyi therapy is less than 90 kcal / kg per day (for the first week of life). - All babies by the end of the first week of life totally do not get the 80-90 kcal / kg per day, - Inability to enteral nutrition (surgical pathology, NEC ALV). For the HRP using any vein, but in young children the opportunity to access venous limited. The most frequently performed major vascular catheterization in Seldynheru. Need a reliable external fixation catheter, the child could not remove it. Under certain conditions it is possible longstanding HRP and through peripheral veins, particularly in older children. Peripheral vein. Kateterizuyutsya by butterflies and peripheral catheters. Do not enter glucose solutions with concentrations greater than 12.5%! Less risk of thrombotic and infectious complications. Peripheral catheters used in neonates with adequate venous access in the case when the projected need for parenteral nutrition for a long time. Concentration of solutions are introduced, should be no more than 10%, because at higher concentrations the risk of complications when ingested solutions under the skin is very large. In a parenteral nutrition via peripheral veins may provide calorie content of 80 to 90 kcal / kg / day if the glucose solution used in combination with fat emulsions. The central vein. Silastic Broviac catheter - a catheter with Rg-contrast label. External diameter - 1.3 mm. Deep venous line installation puncture (can not be used for transfusion of blood, blood products, blood). Central venous catheters are recommended in cases where there is no access to peripheral veins need high calorie content, and limit the amount of fluid injected and Child with HMT (low birth weight), if the expected long-term parenteral nutrition - up to 2 weeks or more. As an energy substrate by HRP in children using mainly glucose, which is the most physiological energy source. Wide range of applications receiving fat emulsion. Apply in pediatrics as solutions of fructose, invert sugar, sorbitol, xylitol. Parenteral nutrition of children can be a system of balanced parenteral nutrition (the Scandinavian system) and the system hiperalimentatsii (system Dadrika). The principal difference is their use as energy substrates glucose and fat - in the first case and only glucose in the second. For both systems characterized by the simultaneous introduction of plastic and energy substrates. All drugs must be administered at the minimum speed (within 22-24 hours), which provides maximum assimilation imposed substances and reduces the possibility of complications. Preparations protein can be mixed with concentrated solutions of glucose, electrolytes, vitamins and trace elements. Mixing these substances in a reservoir of fat emulsions is not allowed. Parenteral nutrition for a balanced system characterized by the introduction of doses of nutrients that meet the normal needs of the body, and can be held for a long time through peripheral veins in children of any age. Up to 40% of energy needs provided by the oxidation of neutral fat that is introduced in the form of fat emulsions. The need for carbohydrates offset input 10-15% glucose solution. When parenteral nutrition is necessary for the system hiperalimentatsiyi catheterization large veins, so that solutions are used, are highly concentrated and can damage the endothelium of veins of small caliber. Long HRP under this system requires increasing tolerance of the body of the child to glucose for 2-3 days, which is achieved by a gradual increase in the concentration of solutions and doses. The main solution is to enter are: glucose solution and any protein product with the addition of the necessary quantity of electrolytes, vitamins and trace elements. Need microelements can be satisfied introduction of plasma 2 times a week for 10 ml / kg. Cancel "hiperalimentatsii" spend gradually to avoid hypoglycemic states. Insulin is not normally used. Allowable glycosuria to 1-2% of the administered amount of glucose. Proper conduct of parenteral nutrition and infusion therapy. Proper conduct of parenteral nutrition (HRP) and infusion therapy based primarily on accurate accounting violations, their comparison with the initial condition for reimbursement of necessary physiological needs, loss of water and electrolytes during surgery and due to other causes (drainage, vomiting and so n ). Losses are established on the basis of urine output, accounting discharge from fistulas and determination of plasma electrolytes. Thus, in secret stomach contents of sodium ions in normal is 80 - 150 mg / l, and potassium 8.5 mmol / l, with the ileum - according 40-135 and 5-30 mmol / l. Normal levels of sodium and potassium in the blood plasma was above. When calculating the volume of fluid in the postoperative period could use the following numbers: child aged 3 days to get a day 40-50 ml of liquid pa 1 kg body weight, aged 5 days - 80-90 ml / kg, 10 days - 125 - 150 ml / kg, 3 months - 140-160 ml / kg Child 2 years - 115-125 mg / kg, 10 years - 70-85 mg / kg, 14 years - 50-60 mg / kg. When dehydration intravenous fluids containing 5-10% glucose solution, Ringer's solution. Instead latter can be used more complex salt solutions. In severe hypovolemia initially fill the required volume of blood plasma polyglucin and then injected glucose and saline. In calculating the total amount of fluid can be guided by the above daily rate for children of all ages. Treatment of hydration is to limit or stop taking fluids entering hypertonic solutions of glucose, heart stimulants. Newborns do not have stocks of nutrients and therefore tolerance to reduced hunger in them, especially when it appears related diseases. That is why nutrition should begin from 24 to 72 hours of life, because the main goal - to prevent weight loss and ensure growth. Typically, a premature baby should be administered parenteral nutrition, which should continue until the amount of enteral nutrition will be quite adequate for meeting all the child's body. The daily energy requirement: 1 day lives - 10 kcal / kg 3 night life - 30 kcal / kg 5 night life - 50 kcal / kg 7 day life - 70 kcal / kg 10 day life - 100 kcal / kg from 2 weeks to 1 year - 110-120 kcal / kg The need for energy: Calculation of energy needs for premature infants leads to mistakes, if applicable general recommendations without consideration of factors that affect this need, for example, the cost of energy. Recommendations for energy needs to be individualized, and we take into account its costs. Daily demand fetus / baby in energy kcal / kg / day Revenues 90-160 Losses 70-130 ● Costs 60-100 - Metabolic rate at rest 45-65 - Activity 10.5 - Synthesis / food thermogenesis 10-25 - "Factor disease?" ● Эkskretsiya 10-30 Accumulation 20-30 The need for energy: ● Depends on weight, gestational and postnatal age, the way revenues, growth, activity, temperature environment. ● Minimum metabolic rate in full-term baby rises from 35-40-55 kcal / kg / day to 100-120 kcal / kg / day ● Up to 110-180 kcal / kg / day for children with HMT on enteral nutrition ● To ensure proper growth of children with low body weight to income 125-130 kcal / kg / day and 3.5-4 g / kg / day of protein (Denne SC Semin Neonatol. 2001) ● Children on parenteral nutrition require less energy for adequate growth - 70-90 kcal / kg / d and 2,4-2,8 g / kg / d protein ● 100 kcal / kg / day in termoneytralnomu environment with minimum activity, complete digestion. ● Sick Children in stressful situations (sepsis, surgery, BPD) require more energy, but no more than 165-180 kcal / kg / day ● When a power 50-105 kcal / kg / day is the synthesis of fat from glucose. ● Revenues energy by increasing glucose only energy inefficient and imposes an additional burden on the respiratory system ● More than physiological in terms of energy balance and gas exchange revenues are intravenous nonprotein calories in the form of a combination of glucose and fat. ● The ideal ratio is achieved when energy flow Carbohydrate, 40-60% Fats 10-50% Proteins 8-12% The need for glucose: ● Glucose / in of major calories (40-60%). ● Monohidratna form of glucose for / in the introduction of the full oxidation gives 3.4 kcal with 1 g of glucose (34 kcal/100 ml of 10% glucose). ● The peripheral veins - to 12.5% in the central - up to 25% glucose. ● glucose infusion rate is expressed in mg / kg / min The initial rate of glucose in children with HMT 6-8 mg / kg / min (In term 3-5, adults 2-3 mg / kg / min) By the 14th day of life glucose tolerance increased to 12-14 mg / kg / min Glucose solution: pH 3,1-3,5 10% glucose (risk of acidosis) Starter Solution ● If less weight 0,8-1 kg - 5% ● If less weight 1,0-1,2 kg - 7.5% ● If the mass of a 1.2 kg - 10% Mandatory monitoring of blood glucose in 12 hours! Gradual increase glucose load (step - 2.5% - 1.2 g / kg / day) Load 12-14 mg / kg / min. Exceeding this dose may interfere with the utilization of fats and lead to fatty liver! In addition, the utilization of glucose doses may lead to excessive production of carbon dioxide! The need for insulin: If your blood sugar levels on a background of parenteral nutrition is 9.8 mmol / l, the rate of glucose utilization is increased, accompanied by glucosuria, increased mortality, the development of the MSC. At this rate of hyperglycemia of glucose reduces the minimum to 4 mg / kg / min. If this persists hyperglycemia more than 8 mmol / l, spend ynfuziyu insulin 0,005-0,1 IU / kg / hour, followed by dose adjustment. If your blood sugar is more than 10-12 mg / dL - the rate of glucose utilization is reduced (appointed insulin infusion). Insulin: ● In case of hyperglycemia may use infusion solution simple insulin (0.05-0.1 U / kg / hour). Insulin is diluted by 0.9% NaCl solution or 5% glucose solution and injected through a separate venous access. ● Continuous infusion of insulin was relatively safe and effective in premature babies. There were no serious adverse effects. While existing treatment protocols response to insulin infusion was significantly delayed in children with NMT. The need for fats: ● Provide 10-50% caloric ● Low content of adipose tissue and carnitine in premature complicates utilization of free fatty acids. ● It is recommended to use 20% fat emulsion containing less phospholipids. ● The initial dose of fat emulsion 0.5-1.5 g / kg / d, with subsequent increase of 0.5-1g / kg / d to achieve 3-3.5 g / kg / d. ● To provide the body essential fatty acids fat income should not be less than 0.5 g / kg / d ● Limit the input of fat to 0.5 g / kg / d with active infectious process and severe lung diseases, with hyperbilirubinemia Calories 20% intralipid ® (Fresenius Kabi) 2 kcal / mol Control the level of triglycerides, without exceeding the level of 150 mg / d With the introduction of fats: ● Fat emulsions should arrive within 24 hours (not less than 20 hours) ● Fat emulsion is mixed with transparent solutions ● You can use "tee" before venous access. ● In the case of a central "lines" fat emulsion served in another vein. ● A mixture of fat emulsions with vitamins and extension cord should be wrapped with foil. ● For the infusion of fat emulsion should use a filter. The need for fats: ● "Early" (≥ 5 days of life) designation lipids can not be recommended for rapid growth or prevent morbidity and mortality of preterm infants ● Fat emulsions (Lipofundin MCT / LCT, intralipid) begin to use the end of the first week of life, if you believe that up to 7 - 10 days of life the child will absorb 70 - 80 kcal / kg enteral. Fat emulsions: Lipids. Prior to the introduction of lipids to determine: - ALT - ACT - Bilirubin - Level tryhlytseridiv Further determination of ALT and AST once a week! Control: tryhlytseridiv level should not exceed (3 - 3.5 mmol / l) rate (1.7 mmol / l). Infusion rate should not exceed - 1.6 ml / kg hour (150 mg / kg / hour, 0.4 g / kg / hour) With high content of fatty acids in plasma significantly increases their absorption and oxidation in liver during the synthesis tryhlytseridiv, leading to ketoacidosis. In addition, the shortage of phosphates and choline neutral fat deposited in the liver, causing fatty infiltration, and in the most severe cases - fatty. Protein requirements: ● 8-12% of the total calories. ● Value protein: nonprotein calories should be 1: 25-30. ● It should limit phenylalanine and methionine. ● You should put enough tyrosine, cysteine and taurine, glycine, arginine ● Revenues amino 1-1.5 g / kg / d provides a zero balance protein in children with HMT ● For children with growth NMT is a need for admission protein 3-3.5 g / kg / d with an adequate flow of energy. ● Children with NMT tolerate parenteral amino income ~ 4 g / kg / d. It is associated with a moderate increase in serum urea and average weight gain without significant acidosis. ● limit the intake of protein in children with stress up to 2.5 g / kg / d (risk of cholestasis). ● Revenues more protein 5-6 g / kg / d may be dangerous. Control tolerance to protein: Violation of tolerance to the protein may appear as: -Increased urea and creatinine -Increase in plasma ammonia -Metabolichnyy acidosis Insufficient intake of proteins: -Increased urea nitrogen (catabolism) -Low albumin / prealbuminu serum -Lack of weight gain despite adequate revenues calories -Rapid weight gain due to edema Preparations of amino acids: Solutions of crystalline amino acids begin to be used for parenteral nutrition baby when: ● energy supply reaches 60-70 kcal / kg / day (2-3 days). ● If the child's condition at this point of time or stabilized immediately after stabilization of central hemodynamics and gas exchange, if it occurs after the 2nd day of life. For parenteral feeding infants only used solutions of crystalline amino acids, containing a complete set of amino acids that are necessary for infants. Ctartova dose district amino acids is 0.5 g / kg / day with increased her every other day at 0.25-0.5 g / kg / day to 2.0-2.5 g / kg / day. Assuming it takes to control total protein, urea, creatinine, uric acid, bilirubin levels. Total Control: Clinical analysis of blood every 2-3 days. Do not through catheters for parenteral nutrition enter medications your sample of blood transfused blood products. Vitamins: Vitamins, water soluble and fat, served in fat emulsion. If lipids are not introduced, the water-soluble vitamins are served in a solution of glucose and amino acids. Drugs: Soluvit N ® (Fresenius Kabi) - soluble Vitalipid infant N ® (Fresenius Kabi) - soluble The dose of 1 ml / kg / day Start pryminyaty vitamins: fat soluble simultaneously with fats soluble in conjunction with amino acids. Trace elements: Drug Peditrace ® (Fresenius Kabi) The dose of 1 ml / kg of 2 weeks of life. Trace Zn - 100 - 300 mg / kg Cu - 15 - 30 mg / kg Mn - 2 - 10 mg / kg Cr - 0.14 - 0.2 mg / kg P - 30-60 mg / kg At the 1st week of life to administered zinc 400 mg / kg / day (6.1 mmol / kg / day Injectable Zn (Laboratoire Aguettant) in 1 ml of 1 mg of zinc, 10 ml vials Algorithm HRP: ● Quantification of fluid ● decision on the use of drugs special ● Quantification of concentrated electrolyte solutions ● Determination of amino acid solution ● Determination of fat emulsion ● Determination of glucose ● Correction of correlations between plastic and energy substrates ● Distribution of drugs during the day Rating Food: Growth: - Daily weighing - Weekly measurement of head circumference and grow Indicators exchange: - Glucose, electrolytes First 2-3 days daily, then 2 times a week - Urea, creatinine, calcium, phosphorus, magnesium, total protein, albumin, total and direct bilirubin, alkaline phosphatase, cholesterol, triglycerides, hematocrit Every week or every 2 weeks - Specific density of urine recovery of substance, the total Daily Complications of parenteral nutrition: 1. Metabolic - Hyper-hypoglycemia - Electrolyte disorders - Violation of vitamin metabolism - Hyperlipidemia - Deficiency of essential fatty acids - Accumulation of aluminum and chromium - Acidosis - Azotemia hyperammoniyemiya - Violation aminohramy plasma 2. Infectious. -Degradation child receives IW, primarily physician should give the idea of sepsis. If, within 48 hours of the antibiotic or antibiotics after changing condition does not improve, you should remove all catheters for HRP, which is a hotbed. 3. Mechanical. - Break catheter - Breaks catheter - Damage to the catheter - Catheter thrombosis - Thrombophlebitis - Hydrothorax, pneumothorax, hemothorax, the syndrome of the upper (lower) Polo veins breach outflow from the limb vessels, perforating vessels. Materials for self- Situational tasks: Task 1. Infant weighing 1.980 kg operated on the second day of life on esophageal atresia, membranous form. For the parenteral nutrition child should spend katerizatsiyu vein and prevent complications. 1. What access should be used for the HRP? 2. What solutions as an energy source is used primarily in infants? 3. The main criteria of HRP. 4. What complications should prevent a child? 5. What are the main metabolic complications. Responses. 1. Central venous catheters are recommended in cases where there is no access to peripheral veins need high calorie content, and limit the amount of fluid injected and Child with ENMT if the expected long-term parenteral nutrition - up to 2 weeks or more. 2. As an energy substrate by HRP in children using mainly glucose, which is the most physiological energy source. 3. Proper conduct of parenteral nutrition (HRP) and infusion therapy based primarily on accurate accounting violations, their comparison with the initial condition for reimbursement of necessary physiological needs, loss of water and electrolytes during surgery and due to other causes (drainage, vomiting, etc. n). 4. The child may experience complications HRP: metabolic, infectious, mechanical. 5. Metabolic complications: - Hyper-hypoglycemia - Electrolyte disorders - Violation of vitamin metabolism - Hyperlipidemia - Lack эssentsyalnыh fatty acids - Accumulation of aluminum and chromium - Acidosis - Azotemia hyperammoniemiya - Violation aminohramy plasma Task 2. Infants with low birth weight 920hr receives parenteral nutrition from the second day of life a system hiperalimentatsiyi. 1. Which veins need katerizuvaty? 2. What is the main requirement for the HRP under this system? 3. Due to what will be satisfied with microelements? 4. How to spend abolition of hiperalimentatsiyi to prevent complications? 5. Complications during HRP. Responses. 1. When parenteral nutrition is necessary for the system hiperalimentatsii catheterization large veins, so that solutions used are highly concentrated and can damage the endothelium of small caliber veins. 2. Long HRP under this system requires increasing tolerance of the body of the child to glucose for 2-3 days, which is achieved by a gradual increase in the concentration of solutions and doses. The main solution is to enter up of glucose and any protein product with the addition of the necessary quantity of electrolytes, vitamins and trace elements. 3. Need microelements can be satisfied introduction of plasma 2 times a week for 10 ml / kg. 4. Cancel "hiperalimentatsii" spend gradually to avoid hypoglycemic states. Insulin is not normally used. Allowable glycosuria to 1-2% of the administered amount of glucose. 5. The child may experience complications HRP: metabolic, infectious, mechanical. Problem 3. Infant with low birth weight had surgery for acute forms of Hirschsprung disease. His condition was grave. The child is shown parenteral nutrition. 1. The principle purpose HRP. 2. Which indicators will be assessed loss? 3. What glucose solution should Apply a child? 4. What complications arise when the wrong appointment glucose solutions? 5. Complications during IW, Responses. 1. Proper conduct of parenteral nutrition (HRP) and infusion therapy based primarily on accurate accounting violations, their comparison with the initial condition for reimbursement of necessary physiological needs, loss of water and electrolytes during surgery and due to other causes (drainage, vomiting, etc. n). 2. Losses are established on the basis of urine output, accounting discharge from fistulas and determination of plasma electrolytes. 3.Rozchyny glucose: pH 3,1-3,5 10% glucose (risk of acidosis) Starting pp: ● If weight less than 0,8-1 kg - 5% ● If weight less than 1,0-1,2 kg - 7.5% ● by weight more than 1.2 kg - 10% Mandatory monitoring of blood glucose in 12 hours! Gradual increase glucose load (step - 2.5% - 1.2 g / kg / day) Load 12-14 mg / kg / min. 4. Exceeding this dose may interfere with the utilization of fats and lead to fatty liver. In addition, the utilization of glucose doses may lead to excessive production of carbon dioxide. 5. Complications of parenteral nutrition: I. Metabolic - Hyper-hypoglycemia - Electrolyte disorders - Violation of vitamin metabolism - Hyperlipidemia - Deficiency of essential fatty acids - Accumulation of aluminum and chromium - Acidosis - Azotemia hyperammoniemiya - Violation aminohramy plasma II. Infectious. -Deterioration of children receiving HRP, primarily physician should give the idea of sepsis. If, within 48 hours of the antibiotic or antibiotics after changing condition does not improve, you should remove all catheters for HRP, which is a hotbed. III. Mechanical. - Break catheter - Breaks catheter - Damage to the catheter - Catheter thrombosis - Thrombophlebitis - Hydrothorax, pneumothorax, hemothorax, the syndrome of the upper (lower) Polo veins breach outflow from the limb vessels, perforating vessels. Problem 4. The baby was born prematurely with a defect intestine weighing 1 kg 150 g underwent operations on the high intestinal obstruction. Determine the tactics of the child. 1. Justify the need for parenteral nutrition indications. 2. Which accesses used in children for HRP? 3. How estimated efficiency HRP? 4. What is the need for energy in this child? 5. Complications during HRP. Responses. 1. Indications for early HRP in newborns: - Premature babies weighing less than 1.500 kg, which links enteral load and ynfuziynoyi therapy is less than 90 kcal / kg per day (for the first week of life). - All babies by the end of the first week of life totally do not get the 80-90 kcal / kg per day, - Inability to enteral nutrition (surgical pathology, NEC ALV). 2. For the HRP using any vein, but in young children the opportunity to access venous limited. The most frequently performed major vascular catheterization in Seldynheru. Need a reliable external fixation catheter, the child could not remove it. Under certain conditions it is possible longstanding HRP and through peripheral veins, particularly in older children. 3. Rating Food: Growth: - Daily weighing - Weekly measurement of head circumference and grow Indicators exchange: - Glucose, electrolytes First 2-3 days daily, then 2 times a week - Urea, creatinine, calcium, phosphorus, magnesium, total protein, albumin, total and direct bilirubin, alkaline phosphatase, cholesterol, triglycerides, hematocrit. Every week or every 2 weeks - Specific density of urine recovery of substance, total. Daily 4. The need for energy: Calculation of energy requirements in preterm infants leads to mistakes, if applicable general recommendations without consideration of factors that affect this need, for example, the cost of energy. Recommendations for energy needs to be customized, and we take into account their costs. Daily energy needs baby kcal / kg / day Revenues 90-160 Losses 70-130 ● Costs 60-100 - Metabolic rate at rest 45-65 - Activity 10.5 - Synthesis / food thermogenesis 10-25 - "Factor disease?" ● Excretion 10-30 Accumulation 20-30 5. Complications of parenteral nutrition: I. Metabolic - Hyper-hypoglycemia - Electrolyte disorders - Violation of vitamin metabolism - Hyperlipidemia - Lack эssentsialnyh fatty acids - Accumulation of aluminum and chromium - Acidosis - Azotemia hyperammoniyemiya - Violation aminohramy plasma II. Infectious. -Degradation child receives IW, primarily physician should give the idea of sepsis. If, within 48 hours of the antibiotic or antibiotics after changing condition does not improve, you should remove all catheters for HRP, which is a hotbed. III. Mechanical. - Break catheter - Breaks catheter - Damage to the catheter - Catheter thrombosis - Thrombophlebitis - Hydrothorax, pneumothorax, hemothorax, the syndrome of the upper (lower) vena cava, a violation of the outflow from the limb vessels, perforating vessels. Problem 5. Child performed after surgery performed parenteral nutrition. In place of a catheter for HRP two days ago, an edema, signs of inflammation, the condition worsened, febrile temperature. Antibiotic therapy did not improve the child's condition. 1. When using peripheral catheters for HRP? 2.Do which type should include a complication HRP? 3. What tactics to further conduct IW? 4. What mechanical complications can occur during the HRP? 5. Principles of proper conduct HRP. Responses. 1. Peripheral catheters used in neonates with adequate venous access in the case when the projected need for parenteral nutrition for a long time. Concentration of solutions are introduced, should be no more than 10%, because at higher concentrations the risk of complications at the hit of solutions under the skin is very large. In a parenteral nutrition via peripheral veins may provide calorie content of 80 to 90 kcal / kg / day, if the glucose solution used in combination with fat emulsions. 2. Infectious complications treated by general principles of treatment of septic conditions. 3. If within 48 hours from the start of antibiotic treatment or after a change of antibiotics condition does not improve, you should remove all catheters for HRP, which is a hotbed. 4. Mechanical complications. - Break catheter - Breaks catheter - Damage to the catheter - Catheter thrombosis - Thrombophlebitis - Hydrothorax, pneumothorax, hemothorax, the syndrome of the upper (lower) vena cava, a violation of the outflow from the limb vessels, perforating vessels. 5. Proper conduct of parenteral nutrition (HRP) and infusion therapy based primarily on accurate accounting violations, their comparison with the initial condition for reimbursement of necessary physiological needs, loss of water and electrolytes during surgery and due to other causes (drainage, vomiting and so n ). Losses are established on the basis of urine output, accounting discharge from fistulas and determination of plasma electrolytes. Quiz.
2. Principles of HRP. 3. Identify the group of drugs for HRP their mechanism of action. 4. Identify methods of control of HRP. 5. Identify complications HRP. Yüklə 0,88 Mb. Dostları ilə paylaş:
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