Frequently asked questions
New consult for TPN
Please order SURGICAL NUTRITION CONSULT (not CLINICAL NUTRITION CONSULT). Surgical nutrition team will see patient on Monday. Can order TPN labs and PICC consult in advance to start the process.
Home TPN patient in ER or admitted to hospital.
Please order SURGICAL NUTRITION CONSULT. Surgical nutrition team will see patient on Monday.
Recommend ordering a daily IVF plan equivalent to the home TPN volume. Most patients should know the volume of their TPN. Most patients followed by Surgical Nutrition have a home TPN order uploaded to the MEDIA section of the EPIC chart. Can call home infusion provider (usually Optioncare – 431-1300 or Amerita – 431-9020) to obtain copy of TPN order.
Most of the Home TPN admissions are for fever and r/o central line infection, problem with central line (occlusion, malposition), dehydration, or new medical issue – so best NOT to start TPN in the hospital until Surgical Nutrition team can see and evaluate.
If asked if patient can infuse their OWN TPN (brought it in with them) – answer is NO, because pumps have not been approved by RIH BIOMED Engineering and pharmacy cannot verify TPN formula with original order.
Attending requests not waiting until Monday and wants TPN started now.
TPN orders can be placed prior to 1:00 pm. If after 1:00 pm must wait until next day.
Before ordering TPN, please confirm patient is not hyperglycemic or an insulin-dependent diabetic, does not have AKI/CKI, and has normal lytes (otherwise best NOT to start TPN).
Go to ORDER SETS, search for TPN. Click on Adult 2-IN-1 TPN with Lipids/SMOF Lipids Panel. Select TPN (no lipids). TPN order defaults to pre-set volume of 1000 ml and preset additives. The only thing you need to modify is DEXTROSE. Change from 300 g to 200 g. If normal kidney function and normal electrolytes, mag, phos, ACCEPT order as is.
Pharmacy calls because K > 5.2 mEq/L or Phosphorus > 5.0 mg/dL.
Go to current orders, scroll down to Continuous. Click Modify Adult 2-in 1 TPN to make changes. TAKE OUT K and/or PHOS. Order labs for AM.
Called by RN, MD, or Pharm for hyperkalemia, hyperphosphatemia and TPN contains K or Phos.
Verify blood draw not via central line. Repeat peripherally if necessary.
D/C TPN if verified. Hang D10 at same rate TPN was running.
Called by RN, MD, or Pharm for new hyperglycemia.
Get a fingerstick GLU now. Verify blood draw not via central line.
If hyperglycemia uncontrolled, wean and D/C TPN.
Patient is to go to PET scan, MRI, or other procedure and TPN cannot be running,
Decrease rate of TPN to 20 ml/hr x 1-2 hrs, then d/c TPN.
Alternatively, d/c TPN and hang D5 or D10 at same rate.
The partially used bag of TPN is to be discarded, do not reconnect.
For any other situations, contact your Chief, Attending.