Pediatric PN Management and Resources for Ordering PN

• PN Management
• Resources for Ordering PN

PN Management

1. The PN line is a closed infusion system.  Avoid if possible giving I.V. medications through a PN line.  There is a high potential for drug incompatibility.
2. Syringes 10 mL must be used to access CVL lines to avoid excessive PSI that could cause catheter tear.
3. All PN orders must be sent to the pharmacy before 2 pm for Pediatrics.
4. Daily weights
5. PN protocol labs are ordered every Monday and Thursday and prn.
6. Cycled PN, chemstrips are ordered every night 2 hours after starting the PN and 1 hour after completion of PN cycle.
7. Unstable blood sugar levels - 2 hrs tapering may be ordered.  Chemstrips should be ordered 3 hrs after starting PN and 1 hour after completion of PN cycle
8. Different amino acids:
   • Trophamine (amino acid) not compatible with Lipids.  Infuse separately.
   • Premasol (comparable with Trophamine)
   • Freamine
   • Clinisol
9. Profile Mode:  (PN program in IV pump) How to Use

Parenteral Nutririon can be administered centrally or peripherally. If administering peripherally you must consider osmolarity. PN osmolarity is calculated by factoring in electrolytes, minerals, lipids, dextrose and amino acids.

1. This measurement can be located on the label of the PN/PN bag and in the MAR. 
2. Peripheral PN (PPN) Catheter tip lies in a peripheral vein and therefore can NOT be cycled due to high risk of excoriation to peripheral vein. OSMOLARITY CAN NOT exceed 990 osmol/L.
3. Central PN (CPN) catheter tip lies in the lower 1/3 portion of the superior vena cava (SVC) or cavoatrial junction and can be cycled (LLUMC policy # R-15). Because the SVC is a large vessel osmolarities that exceed 990osmol/L is acceptable.

Resources for Ordering PN:

1. How to find Home PN Program in LLEAP
2. How to Enter Order for In-Patient PN
3. How to Enter Order for Home PN
4. PN Med Compatabilities
5. Request for Enteral Nutrition Products (CCS) Sample - Obtain form from Unit Secretary