# TPN calculator

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Published on September 20, 2007

Author: doc4child

Source: authorstream.com

TPN Calculator:  TPN Calculator Dr Jaimin Patel PGY-1 Pediatrics How many total TPN Orders.:  How many total TPN Orders. 15-30 from NICU 2-5 from Intermediate Nursery. Background.:  Background. Errors Osmolarity Calculation Missing information Glucose Rate Accuracy Person to person variation Time consumed What will it look like?:  What will it look like? How will it look like?:  How will it look like? Slide6:  Software:  Software Front End : Visual Basic Express Back End : Database – SQL Server Express Edition. Slide8:  What I will need?:  What I will need? Consensus on Electrolytes adjustment in the TPN based on the S. Electrolyte concentrations Haemolysed samples- K+ Values Dextrose concentrations. Functional Design (Fluids):  Functional Design (Fluids) Fluid Rates For andlt;1000 gms For 1001 to 1500 gms For andgt;1500 gms Rate of increase 15 ? 20 ? Maximum Fluid Rate 150 190 Functional Design (Dextrose):  Functional Design (Dextrose) Minimum 2.5 Max Peripheral 12.5 Central 25 Max Mean S. Glucose level? Criteria for increasing Dextrose conc. Criteria for decreasing Dextrose conc. Functional Design (lipids):  Functional Design (lipids) If baby is andlt;1000 gms TPN day 1 Start Lipids 0.5 gm/kg/day TPN day andgt;= 2 and TPN Lipids andlt;=2.5 gm/kg/day. Previous day TPN Lipids + 0.5 gm/kg/day If baby is andgt;=1000 gms TPN day 1 Start Lipids 1 gm/kg/day TPN day andgt;= 2 and TPN Lipids andlt;=2 gm/kg/day. Previous day TPN Lipids + 1 gm/kg/day Triglycerides if andgt;200 mg/dl IL rate must be decreased. Consider Limiting lipids for Hyperbilirubinemia, Sepsis or PPHN. If baby is more than Half feeds, stop LIPIDs in TPN Functional Design (Amino Acids):  Functional Design (Amino Acids) If baby is andlt;1000 gms TPN day 1 Start Trophamine 1.5 gm/kg/day TPN day andgt;= 2 and TPN Trophamine andlt;=2.5 gm/kg/day. (max 3.5) Previous day TPN Trophamine + 1 gm/kg/day If baby is andgt;=1000 gms TPN day 1 Start Trophamine 2 gm/kg/day TPN day andgt;= 2 and TPN Lipids andlt;=2.5 gm/kg/day. Previous day TPN Trophamine + 1 gm/kg/day If BUN 30 to ___ Decrease Trophamine by ____gm/kg/day If BUN andgt;________ Stop Trophamine. If Cholestasis –S. Bili andgt; __________ Trophamine max 3 gm/kg/day. Electrolytes:  Electrolytes Ranges and mEq/100 ml of TPN Sodium 2-5 mEq/kg/day Potassium 2-4 mEq/kg/day Calcium Gluconate 1-4 mEq/kg/day Cysteine If Blood Gases not available. IF Renal compromise (do not add) Creatinine? Cut off? What I will Need?:  What I will Need? IRB approval. ITR support to plug in the last SMA-7 Values and to develop software. Support from the pharmacist to collect data. Support from attending for the functional Design. Study Design:  Study Design Trailing: 50 orders on Computer. ?Only 2nd year resident TPN orders Same resident for Same patient on two different days. Day1 Half Manual/Half On Computer. Day2 Will Switch the groups. Time spent on the variable collection for the patients will not be counted. He/She should not be 'Post call'. Timing by the residents Himself/Herself. Definition : Medical Error:  Definition : Medical Error The National Coordinating Council for Medication Error and Prevention (NCCMERP), 'A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use Error Detection Method:  Error Detection Method 1st order faxed between 5 AM- 12 noon for the patient will be evaluated. It will be checked for Illegible handwriting Missing information Wrong Calculation Osmolarity Medication errors/fluid rate errors Amphotericin B- change in fluid rate Heparin Data collection : Errors:  Data collection : Errors Data Collection:  Data Collection Questions:  Questions What other things can be measured and compared statistically? Slide22:  http://www.tpncalculator.com

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