Guest guest Posted September 17, 2004 Report Share Posted September 17, 2004 The CHO in TPN shouldn't be an issue for a gastric bypass patient because it is given intravenously...no gut/absorption issues. If your standard solution doesn't provide enough protein, you can recommend a higher percentage of a.a. in solution. Be sure to check with your PharmD to make sure that it is physically possible to create your recommendations! (You will likely have to also lower the CHO percentage for it to all fit in the bag). Our standard solution is 20% dextrose, 6% a.a. but I know we can also make 16% dextrose with 7% a.a. for people who need more protein and/or less dextrose for blood sugar issues. Hope this helps. Let me know if you have any other questions. M. Roy, RD, LD St. 's/Duluth Clinic Health System 400 East Third Street Duluth, MN 55805 (218) 786-3143 -----Original Message-----From: Janelle Heusinger [mailto:jheusinger@...]Sent: Friday, September 17, 2004 3:22 PM Subject: Tpn Does anyone use custom TPN for gastric patients. The reason I ask is because our stand does not provide enough protein and too much cho. If so can you tell me what you use. Thanks Janelle Heusinger, RD.,LD. Grinnell Regional Medical Center (641)236-2488 Jheusinger@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2004 Report Share Posted September 17, 2004 Janelle- you should use a custom TPN formula if your hospital can. these patients often have unusual needs when they develop post-op complications from GBP. You want them to heal -but not gain weight- so some CHO is needed, and usually a minimum of 120g/d. Protein needs may be as high as 1.5g/kg actual wt. I am a CNSD and work with the "at home" and LTC iv patients and have seen the GBP patients who have had these post-op complications. they are very challenging, and interesting. Eva H RD LD CNSD -------------- Original message -------------- Does anyone use custom TPN for gastric patients. The reason I ask is because our stand does not provide enough protein and too much cho. If so can you tell me what you use. Thanks Janelle Heusinger, RD.,LD. Grinnell Regional Medical Center (641)236-2488 Jheusinger@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2004 Report Share Posted September 20, 2004 Eva, What calorie level do you provide so that healing takes place? Let's say you have an GBP pt with an abdominal wound and an enteric fistula (who is NPO). I hesitate to skimp on calories when I see these big wounds, but I don't want to go too high either. I'm wondering what your experiences are. Amy Haselbush MS, RD -----Original Message-----From: md-gonzales@... [mailto:md-gonzales@...]Sent: Friday, September 17, 2004 9:48 PM Subject: Re: Tpn Janelle- you should use a custom TPN formula if your hospital can. these patients often have unusual needs when they develop post-op complications from GBP. You want them to heal -but not gain weight- so some CHO is needed, and usually a minimum of 120g/d. Protein needs may be as high as 1.5g/kg actual wt. I am a CNSD and work with the "at home" and LTC iv patients and have seen the GBP patients who have had these post-op complications. they are very challenging, and interesting. Eva H RD LD CNSD -------------- Original message -------------- Does anyone use custom TPN for gastric patients. The reason I ask is because our stand does not provide enough protein and too much cho. If so can you tell me what you use. Thanks Janelle Heusinger, RD.,LD. Grinnell Regional Medical Center (641)236-2488 Jheusinger@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2004 Report Share Posted September 20, 2004 Hi Janelle, We customize all our TPN in 24 hour bags. We give a high protein, hypocaloric formula that provides 2 gm pro/kg ibw/d and generally between 14-18 kcal/kg actual wt/day. The volume is dependent on the patients fluid needs and the volume required to provide the specific ingredients in a stable three-in-one solution. We monitor N2 balance weekly and have been successful in achieving +N2 balance, wound healing, along with weight loss. Suzanne Lugerner MS RN CNSN CNS Janelle Heusinger wrote: Does anyone use custom TPN for gastric patients. The reason I ask is because our stand does not provide enough protein and too much cho. If so can you tell me what you use. Thanks Janelle Heusinger, RD.,LD. Grinnell Regional Medical Center (641)236-2488 Jheusinger@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 7, 2006 Report Share Posted October 7, 2006 Hi , I have a reference at work on TPN and bariatric surgery pts . Basically it says 15 to 20 kcals per kg of calculated metabolic weight with 1.5 to 2.0 gm protein per kg. I will try to get it for you when I go into work on Tuesday. Hope this is helpful. a Serafino-Cross, MS, RD Springfield, MA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2006 Report Share Posted October 12, 2006 a, I would also be interested in seeing the reference for this. Thanks in advance. Dana M. Holland Clinical and Outpatient Dietitian Highland Park Hospital 847.480.2634 Re: tpn Hi , I have a reference at work on TPN and bariatric surgery pts . Basically it says 15 to 20 kcals per kg of calculated metabolic weight with 1.5 to 2.0 gm protein per kg. I will try to get it for you when I go into work on Tuesday. Hope this is helpful. a Serafino-Cross, MS, RD Springfield, MA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 13, 2006 Report Share Posted October 13, 2006 Hi Dana and other list serve members, The article that I have is entitled "Nutritional Considerations after Bariatric Surgery" by Elliot, RD, CNSD in Critical Care Nursing Quarterly, Vol 26, No.2, pp133-138. The section on TPN states that we should be on alert for refeeding syndrome and start with 50% of estimated needs and 50% of fluid. Calorie needs should be based on calculated metabolic weight, not actual or ideal weight. It is suggested that calories should be 15 to 20 /kg CMW and protein 1 to 2 gms per kg/CMW. Hope this is helpful. a Serafino-Cross, MS, RD, LDN Bariatric Dietitian Springfield, MA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 13, 2006 Report Share Posted October 13, 2006 I'm curious about the CMW, is there a formula? Re: tpn Hi Dana and other list serve members, The article that I have is entitled "Nutritional Considerations after Bariatric Surgery" by Elliot, RD, CNSD in Critical Care Nursing Quarterly, Vol 26, No.2, pp133-138. The section on TPN states that we should be on alert for refeeding syndrome and start with 50% of estimated needs and 50% of fluid. Calorie needs should be based on calculated metabolic weight, not actual or ideal weight. It is suggested that calories should be 15 to 20 /kg CMW and protein 1 to 2 gms per kg/CMW. Hope this is helpful. a Serafino-Cross, MS, RD, LDN Bariatric Dietitian Springfield, MAr Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 13, 2006 Report Share Posted October 13, 2006 me 2 Re: tpn Hi Dana and other list serve members, The article that I have is entitled "Nutritional Considerations after Bariatric Surgery" by Elliot, RD, CNSD in Critical Care Nursing Quarterly, Vol 26, No.2, pp133-138. The section on TPN states that we should be on alert for refeeding syndrome and start with 50% of estimated needs and 50% of fluid. Calorie needs should be based on calculated metabolic weight, not actual or ideal weight. It is suggested that calories should be 15 to 20 /kg CMW and protein 1 to 2 gms per kg/CMW. Hope this is helpful. a Serafino-Cross, MS, RD, LDN Bariatric Dietitian Springfield, MAr Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2006 Report Share Posted October 15, 2006 Calculated Metabolic weight is the same as adjusted weight. It is actual weight minus ideal weight times 0.25 plus ideal weight. If we use actual weight we would end up overfeeding. If we used ideal weight we would underfeed. I also forgot to mention that the article that I was referring to was published in 2003. Hope this is helpful. Take care. a Serafino-Cross, MS, RD, LDN Bariatric Dietitian Baystate Medical Center Springfield, MA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2006 Report Share Posted October 15, 2006 Some others use the midpoint between ideal and actual wt as the metabolic wt. This was verified for hospitalized pts for BMI up to 50 kg/m2 (somewhere around this BMI). Glynn et al. 1999 either JADA or JPEN. From: [mailto: ] On Behalf Of Humnut413@... Sent: Sunday, October 15, 2006 3:41 PM Subject: Re: tpn Calculated Metabolic weight is the same as adjusted weight. It is actual weight minus ideal weight times 0.25 plus ideal weight. If we use actual weight we would end up overfeeding. If we used ideal weight we would underfeed. I also forgot to mention that the article that I was referring to was published in 2003. Hope this is helpful. Take care. a Serafino-Cross, MS, RD, LDN Bariatric Dietitian Baystate Medical Center Springfield, MA Quote Link to comment Share on other sites More sharing options...
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