TPN Evaluation Question

[DukeSilverofNevada]

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Hi,

What kind of activity is performed during a "TPN" pharmacy clinical evaluation?

Are any of the TPN lines manipulated during this process?

Any feedback is much appreciated.

 

[confettiflyer]

I don't go anywhere near physical lines on a patient.

Under protocol we consult with the dietitians for their macronutrient needs (or just calculate it if they're unavailable for some reason) and adjust electrolytes as needed. So the clinical evaluation is from a nutrition standpoint, electrolyte standpoint, and clinical status in general.

 

[DukeSilverofNevada]

I don't go anywhere near physical lines on a patient.

Under protocol we consult with the dietitians for their macronutrient needs (or just calculate it if they're unavailable for some reason) and adjust electrolytes as needed. So the clinical evaluation is from a nutrition standpoint, electrolyte standpoint, and clinical status in general.

Thanks confettiflyer, that is very helpful.

 

[Dred Pirate]

how many of you manage electrolyte levels with a TPN? ASPEN guidelines say you shouldn't adjust electrolytes with the TPN - you should do so via bolus (ex: replacement protocols) - obviously if they are high, you can reduce, but you shouldn't really increase the TPN amount because of a low lab.

 

[confettiflyer]

how many of you manage electrolyte levels with a TPN? ASPEN guidelines say you shouldn't adjust electrolytes with the TPN - you should do so via bolus (ex: replacement protocols) - obviously if they are high, you can reduce, but you shouldn't really increase the TPN amount because of a low lab.

Yeah I really don't actively adjust electrolytes with a TPN, that's like steering a boat while looking aft.

What I usually do is just have basic replenishment levels at a predetermined base amount and remove only if levels are at high normal or above. On day #2, labs are drawn in the AM and half the bag has infused so you can't really make a determination there either.

If K comes back low, for example, we'll replace outside of TPN w/ K-riders and slowly increase the TPN amount by some amount. Even if we need to aggressively replace something, the increases within TPN are conservative.

 

[BidingMyTime]

The idea of physically manipulating a TPN line sounds scary, surely no pharmacist is doing that? We have a basic protocol, doctors can modify the protocol and pharmacists can make recommendations towards modifying, but most doctors just go with the basic (other than adding in insulin) There is one older doctor who insists on modifying his TPN's based on the daily labs of his patients.....our director has given up arguing with him about this, but yeah, generally TPN's don't have to be changed much after the initial order.

 

[deleted205891]

We just evaluate electrolytes and other additives (not macronutrients, nutrition does that) and contact the provider with any recommendations.