COVID 19 –靜脈營養重點(British Dietetic Association)
2020.04.07營養師趙強譯
1. 靜脈營養(PN)應是萬不得已的方法，在此期間，應在給予PN之前進行腸道營養的嘗試。若需使用PN，即使很少量，也要盡可能與PN一起餵食。
2. 使用一同補充維生素與微量元素的多室袋(Multi-Chamber Bag, MCB)作為一線方式，或單獨輸注靜脈注射維生素和微量元素。此外，若患者能藉由腸胃進食與吸收這些營養素，則可開立處方補充微量營養素，例如Forceval。此時，PN就不需給予。
3. 從每公斤供應熱量的最少量開始，然後進行監控。遵循PENG的準則進行餵食、估計營養需求和監測。
4. 每天監測尿素和電解質(U＆E)、鎂、磷、鈣、肝功能檢查(LFT)，CRP與全血細胞計數(FBC)，直至穩定。
5. 每四個小時監測血糖直至穩定。
6. 密切監測體液平衡，尤其是排泄物、嘔吐物/鼻胃抽吸物和造口/瘻管的損失。
7. 不要過量攝取葡萄糖或脂質，特別是重症患者。
8. LFT的異常可能是由於藥物，包括抗生素和/或敗血症，而不是短期PN引起的。考慮給予以魚油為基礎的MCB。
9. 如果代謝穩定，週期性PN(12-16小時)，對LFT紊亂有幫助。
10. 我們目前無法給予出院患者居家靜脈營養(Home Parenteral Nutrition, HPN)，因此應嘗進行所有可能使用的腸道途徑(包括由鼻胃管給予經口的水分補充）的嘗試。
11. 如果HPN患者入院，請聯繫平時照顧他們的團隊以尋求建議。
＝＝ 原文 ＝＝
COVID 19 – Parenteral Nutrition Top Tips
1. Parenteral Nutrition (PN) should be a last resort and all attempts at enteral nutrition should be tried before PN during this time. If PN needs to be used feed enteral alongside PN if at all possible, even if a small volume.
2. Use Multi-Chamber Bag (MCB) supplemented with vitamins and trace elements as first line or separate infusion of intravenous vitamins and trace elements. Alternatively, a micronutrient supplement such as Forceval could be prescribed if the patient is able to eat and drink and absorb these enterally. There will be limited compounding for PN during this time.
3. Start at lower end of kcals/kg and monitor. Follow PENG guidelines for refeeding, estimating nutritional requirements and monitoring.
4. Monitor Urea & Electrolytes (U&E), Magnesium, Phosphate, Calcium, Liver Function Tests (LFTs), C-reactive protein (CRP) and full blood count (FBC) daily until stable.
5. Monitor blood glucose every four hours until stable
6. Close monitoring of fluid balance especially losses from drains, vomit/nasogastric aspirates and stoma/fistulae.
7. Don't overfeed glucose or lipid especially in the critically ill.
8. Deranged LFTs may be due to medications including antibiotics and/or sepsis and not short term PN. Consider fish oil-based lipid MCB.
9. Cyclical feeding (12-16 hours) of PN can help with deranged LFTs if metabolically stable.
10. We are currently unable to discharge patients on Home Parenteral Nutrition (HPN) therefore all attempts to use enteral routes (which may include nasogastric tube for oral rehydration solutions) should be tried.
11. If a patient on HPN gets admitted to your hospital please contact the team who normally look after them for advice.)
Source: https://www.bda.uk.com/resource/covid-19-parenteral-nutrition-top-tips.html
