Unique Plan Description: Adult TPN Protocol
Plan Selection Display: Adult TPN Protocol
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2024-01-30 11:57:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-07-23 08:22:19
Available at all facilities: Yes

Adult TPN Protocol
Laboratory
		For critically ill adult patients, consider enteral nutrition when possible. Total Parenteral Nutrition (TPN) should be considered for patients who are unable to meet nutritional requirements with enteral nutrition and are expected to require it for great(NOTE)*
	Basic Metabolic Panel
		T+1;0400, Routine, Q24H, 5, Day(s), spec type = Blood
			Comment: (TPN Protocol)
		T;N, Routine, spec type = Blood
			Comment: (TPN Protocol)
		T+10;0400, Routine, spec type = Blood
			Comment: (TPN Protocol)
	CBC with Diff
		T;N, Routine, spec type = Blood
			Comment: (TPN Protocol)
		T+7;0400, Routine, Q7D-Lab, spec type = Blood
			Comment: (TPN Protocol)
	Chromium Level
		T+14;0400, Routine, Q14D-Lab, spec type = Blood
			Comment: (TPN Protocol)
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
			Comment: (TPN Protocol)
		T+7;0400, Routine, Mon, spec type = Blood
			Comment: (TPN Protocol)
	Copper Level
		T+14;0400, Routine, Q14D-Lab, spec type = Blood
			Comment: (TPN Protocol)
	Magnesium Level
		T;N, Routine, spec type = Blood
			Comment: (TPN Protocol)
		T+1;0400, Routine, Q24H, 5, Day(s), spec type = Blood
			Comment: (TPN Protocol)
		T+10;0400, Routine, Q7D-Lab, spec type = Blood
			Comment: (TPN Protocol)
	Manganese Level
		T+14;0400, Routine, Q14D-Lab, spec type = Blood
			Comment: (TPN Protocol)
	Phosphorus
		T;N, Routine, spec type = Blood
			Comment: (TPN Protocol)
		T+1;0400, Routine, Q24H, 5, Day(s), spec type = Blood
			Comment: (TPN Protocol)
		T+10;0400, Routine, Q7D-Lab, spec type = Blood
			Comment: (TPN Protocol)
		If patient is on warfarin, select BOTH Protime orders below:(NOTE)*
	INR - MH/WH/JE
		T;N, Routine, spec type = Blood
			Comment: (TPN Protocol)
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
			Comment: (TPN Protocol)
		T;N, Stat, spec type = Therapeutic Blood
			Comment: (TPN Protocol)
	INR - MH/WH/JE
		T+7;0400, Routine, Q7D-Lab, spec type = Blood
			Comment: (TPN Protocol)
	Prothrombin Time (PT) - FH
		T+7;0400, spec type = Diagnostic Blood
			Comment: (TPN Protocol)
		T+7;0400, spec type = Therapeutic Blood
			Comment: (TPN Protocol)
	Selenium Level
		T+14;0400, Routine, Q14D-Lab, spec type = Blood
			Comment: (TPN Protocol)
	Triglycerides
		T;N, Routine, spec type = Blood
			Comment: (TPN Protocol)
		T+7;0400, Routine, Q7D-Lab, spec type = Blood
			Comment: (TPN Protocol)
	Zinc Level
		T+14;0400, Routine, Q14D-Lab, spec type = Blood
			Comment: (TPN Protocol)
Diagnostic Tests
	Indirect calorimetry
		T;N
			Comment: TPN Protocol.
IV Solutions
	TPN with Electrolytes - TPN Protocol
		1,800 mL, IV, T;2100, 75 ml/hr, 5 % Amino Acids, 15 % Dextrose, 40 mEq/L Sodium Chloride, 20 mEq/L Sodium Acetate, 15 mEq/L Potassium Chloride, 14 mMol/L Potassium Phosphat, 8 mEq/L Magnesium Sulfate, 4.8 mEq/L Calcium Gluconate, 10mL M W F mL/Bag MVI-Adu
			Comment: Infuse via central line only. TPN rate changes should occur with next bag unless specifically ordered by prescriber.
Patient Care
	Glucose POC - RN
		T;2100, Q6H
	Discontinue IV Fluids
		T;2100
			Comment: Upon TPN initiation (TPN Protocol)
	Central Line-Insert
		T;N
Consults/Follow-up
	Consult Dietitian
		T;N, Regarding: TPN, Dietitian Assess and Treat
			Comment: Pharmacy/Nutrition to order TPN solution, labs and make necessary adjustments.
	Pharmacy Consult - TPN
		T;N, Regarding: TPN | Pharmacy/nutrition to order TPN solution and monitor/adjust electrolytes. Add 100mg Thiamine IV Push daily for 7 days order if patient is at risk for refeeding syndrome. Discontinue Thiamine after 7 days.
			Comment: Pharmacy/nutrition to order TPN solution and monitor/adjust electrolytes. Add 100mg Thiamine IV Push daily x7 days order if patient is at risk for refeeding syndrome. Discontinue Thiamine after 7 days

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase