Unique Plan Description: Adult TPN Renal Protocol
Plan Selection Display: Adult TPN Renal 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: 2024-02-13 14:41:05
Available at all facilities: Yes

Adult TPN Renal 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-Renal Protocol)
		T;N, Routine, spec type = Blood
			Comment: (TPN-Renal Protocol)
		T+10;0400, Routine, spec type = Blood
			Comment: (TPN-Renal Protocol)
	CBC with Diff
		T;N, Routine, spec type = Blood
			Comment: (TPN-Renal Protocol)
		T+7;0400, Routine, Q7D-Lab, spec type = Blood
			Comment: (TPN-Renal Protocol)
	Chromium Level
		T+14;0400, Routine, Q14D-Lab, spec type = Blood
			Comment: (TPN-Renal Protocol)
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
			Comment: (TPN-Renal Protocol)
		T+7;0400, Routine, Mon, spec type = Blood
			Comment: (TPN-Renal Protocol)
	Copper Level
		T+14;0400, Routine, Q14D-Lab, spec type = Blood
			Comment: (TPN-Renal Protocol)
	Magnesium Level
		T;N, Routine, spec type = Blood
			Comment: (TPN-Renal Protocol)
		T+1;0400, Routine, Q24H, 5, Day(s), spec type = Blood
			Comment: (TPN-Renal Protocol)
		T+10;0400, Routine, Q7D-Lab, spec type = Blood
			Comment: (TPN-Renal Protocol)
	Manganese Level
		T+14;0400, Routine, Q14D-Lab, spec type = Blood
			Comment: (TPN-Renal Protocol)
	Phosphorus
		T;N, Routine, spec type = Blood
			Comment: (TPN-Renal Protocol)
		T+1;0400, Routine, Q24H, 5, Day(s), spec type = Blood
			Comment: (TPN-Renal Protocol)
		T+10;0400, Routine, Q7D-Lab, spec type = Blood
			Comment: (TPN-Renal Protocol)
		If patient is on warfarin, select BOTH Protime orders below:(NOTE)*
	INR - MH/WH/JE
		T;N, Routine, spec type = Blood
			Comment: (TPN-Renal 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
	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-Renal Protocol)
	Triglycerides
		T;N, Routine, spec type = Blood
			Comment: (TPN-Renal Protocol)
		T+7;0400, Routine, Q7D-Lab, spec type = Blood
			Comment: (TPN-Renal Protocol)
	Zinc Level
		T+14;0400, Routine, spec type = Blood
			Comment: (TPN-Renal Protocol)
Diagnostic Tests
	Indirect calorimetry
		T;N
			Comment: (TPN-Renal Protocol)
IV Solutions
	TPN with Electrolytes - Renal
		1,200 mL, IV, Routine, T;2100, 50 ml/hr, 24 hr, 7 % Amino Acids, 19 % Dextrose, 40 mEq/L Sodium Chloride, 30 mEq/L Sodium Acetate, 4.8 mEq/L Calcium Gluconate, 10mL M W F mL/Bag MVI-Adult, 1mL M W F mL/Bag Trace Elements, 200 mL/bag fat emulsion20% IV
			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 to TPN daily for 7 days 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 to TPN daily for 7 days 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