Page 631 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

618 SPECIAL THERAPY

Figure 25-6 The catheter for parenteral nutrition should be
placed with aseptic technique and should be a dedicated catheter.

and bags free of DEHP and made with alternatives such
as ethyl vinyl acetate.
Parenteral Nutrition Solutions
For logistical and economical reasons, more than 1 day’s
supply of parenteral nutrition usually is compounded at Figure 25-7 Parenteral nutrition should be infused over a
one time. As such, the bag of parenteral nutrition for 24-hour period by continuous-rate infusion via a fluid pump.
the current day should be set up for the animal, and
the other bags should be stored in a refrigerator until
the time of use. No more than a 5-day supply of parenteral not administered at a faster than desired rate during this
nutrition should be compounded and stored at a time. time) and keep the drip chamber upright. At the end of
However, some authors recommend that no more than each 24-hour period, the infusion should be complete,
a 2-day supply is compounded ahead of time, and this and the empty bag, along with the lines, can be changed
practice may be more appropriate for patients that are using an aseptic technique and a new bag and lines
critically ill in which frequent adjustments to the paren- substituted. All parenteral nutrition should be
teral nutrition admixture may become necessary (e.g., administered through a 1.2-mm in-line filter (extension
decreasing dextrose or lipid content). 66 Parenteral nutri- set with 1.2-mm downstream filter, Baxter Healthcare
tion admixtures should never be frozen, and any unused Corp.), but not all hospitals use these. The filter can help
portions should be discarded (i.e., not saved for use at a to prevent lipid globules or precipitates (particularly
later time or in another patient). calcium phosphate) from being introduced to the
4,51
patient. Because of the high osmolarity of the TPN
Initiating Parenteral Nutrition solution, it should be administered through a central
venous (jugular) catheter. However, some authors have
The worksheets in this chapter provide an admixture that downplayed the role of high osmolality in increasing risk
is intended to last 24 hours when administered at a of thrombophlebitis in people. 36 It is unknown if this
constant-rate infusion. Bags of parenteral nutrition holds true in dogs and cats and further investigation
admixtures should not be at room temperature for more isrequired.PPN(asformulatedusingtheworksheetinthis
than 24 hours. The bag should be administered during chapter) can be administered through a peripheral or
the 24-hour period via a fluid infusion pump jugular catheter, but because it is more dilute, it can only
(Figure 25-7). During this time, the lines should not provide a portion of the patient’s energy requirements.
be disconnected from the bag or the patient (i.e., it TPN should be instituted gradually over 48 to 72
should remain a closed system). When taking dogs out- hours. Most animals tolerate receiving 50% of total
side, either the pump should accompany the dog or the requirements on the first day and 100% on the second
bag can be removed from the pump (if this does not dis- day. Animals that have been without food for long periods
connect the lines from the bag or the patient) and carried may require slower introduction (i.e., 33% on the first
along. In the latter situation, one must be careful to allow day, 66% on the second day, and 100% on the third
the parenteral nutrition to continue to drip slowly (i.e., day). PPN does not require gradual introduction and
avoid clamping it off completely but ensure that it is can be initiated at 100% on the first day. It is important