How to Design Total Parenteral Nutrition

Designing Total Parenteral Nutrition (TPN), can you do this?
How do you order TPN? When is total parenteral nutrition indicated?
Why does TPN seem so complicated and why have I avoided it all this time?
Rest easy, in this video your questions will be answered and your fears relieved!
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MUST HAVE SURGERY BOOKS
Sabiston's Textbook of Surgery citizensurgeon.co/Sabiston
Moore's Clinically Oriented Anatomy citizensurgeon.co/Moore
Netter's Anatomical Atlas citizensurgeon.co/Netter
Schwartz Principles of Surgery citizensurgeon.co/Schwartz
Fischer's Mastery of Surgery citizensurgeon.co/Mastery
Zollinger's Atlas of Surgical Operations citizensurgeon.co/Zollinger
Top Knife (MUST MUST HAVE) citizensurgeon.co/topknife
Over the last few videos we've been building up to this talk with the last two discussions on surgical nutrition and now you're ready to learn about TPN. Today's goal is to understand when TPN is indicated and how you can write and order it! If you haven't had a chance to check out the first two videos definitely check them out here:
Surgical Nutrition Part I - Nutritional Assessment: citizensurgeon.co/nutritionass...
Surgical Nutrition Part II - Fluid and Energy: citizensurgeon.co/fluidandenergy
Surgical Nutrition and TPN is a foundational talk in surgery and you should definitely have a firm grasp on surgical nutrition as an intern and definitely definitely before your board exams! For the medical students out there definitely check these videos out and you'll be ahead of your peers with respect to assessing the nutritional status and delivering nutrition when indicated.
YOU WILL LEARN THE FOLLOWING
1.) Understand the Indications for TPN
2.). Understand the difference between TPN and PPN
3.). Understand how to write a basic TPN order
FAST FORWARD WITH THESE INCREDIBLE TIMESTAMPS
Start 00:00
Goals for the Discussion 03:19
Why is Learning TPN so Important 03:52
Key References 04:31
ESPEN Recommendations 05:39
Indications for TPN 07:11
Peripheral Parenteral Nutrition or Total Parenteral Nutrition? 08:10
Calculating Carbohydrates in TPN 10:17
Calculating Lipids in TPN 11:14
Calculating Protein in TPN 12:56
Sample Calculation for Writing TPN 14:14
How about electrolytes? 17:52
Specific nutrients added to TPN 18:31
Why individualized TPN solutions 19:58
Nutrients and Specific Deficiencies (SCREENSHOT THIS) 21:30
Two in One or Three in One TPN Solutions? 22:19
Is Weaning TPN Necessary? 23:07
Summarizing TPN and Putting it All Together 23:32
REFERENCES
ESPEN Guidelines: citizensurgeon.co/ESPEN
Hitchhikers guide to TPN: citizensurgeon.co/TPN
How to write a TPN order: citizensurgeon.co/writingTPN
Norton's Surgery citizensurgeon.co/Norton
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WHO AM I?
I'm Dr. Erik Pearson, FACS and I am a board certified pediatric surgeon living in Las Vegas. I make surgical education videos on all topics in general surgery as well as talks on lifestyle design as a surgeon, book reviews, and studying effectively. I also write a weekly newsletter called the Saturday Six where I identify Six different discoveries of the week. You can get the weekly newsletter by signing up to the CITIZENSURGEON Community!
DISCLAIMER
While my aim is to help educate you for the ward, the surgical ICU, the operating room and your exams remember these videos are not a replacement for your reading, your medical school and residency preparation and most important your own decision making. Good luck and enjoy!
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[@SJ-hd1br]

Again, thank you so much! You really simplified the information in 30 pages of textbook on this topic.

[@Katy_Sato]

Great learning session there sir. Dietitian from Kenya.

[@tahirfarid2678]

Awesome 👍 and beautifully explained!

[@citizensurgeon]

Tahir! Thanks for the feedback! Let me know if there is another topic you’re interested in learning about!!

[@dr.rekhavarghese5273]

Very helpful . Clear and to the point

[@citizensurgeon]

Thanks so much for the feedback!!

[@emmym.1524]

Not a doctor but I’ve been on TPN for 6 years now and just curious about how it works. Good video! Also if anyone watching this has any questions for a long term TPN patient I’d be happy to answer

[@ChloeDunIT]

Thank you for producing this video, you explain things so much better than the text books!

[@citizensurgeon]

Thanks for the feedback, just finishing a long format video on the trauma assessment, should be out this weekend!

[@MMm-gi5wk]

Thanks so much for a great tutorial! I have only discovered your series this afternoon and have already learnt so much! Would you consider a future learning session on albumin and the role of its measurement and when to supplement post-operatively please? Thanks again! :-)

[@citizensurgeon]

I think I could do a short video on that, for sure thanks for your feedback! Good luck with your studies

[@ivanovech791]

This is so awesome 😊

[@citizensurgeon]

So happy you enjoyed it!!

[@jeenazad2440]

Thank you so much 😊

[@citizensurgeon]

Absolutely! Happy this helped!

[@dr.alishmehta3104]

Just completed the lecture. It was wonderful. Sir, can we've a lecture on surgical audit. Best wishes from India.

[@citizensurgeon]

Alish Mehta thank you Alish! Please let me know what you mean by surgical audit...do you mean how to run an effective M&M?

[@dr.alishmehta3104]

@@citizensurgeon sir, chapter no. 11 of love and bailey , 27 edition

[@citizensurgeon]

Alish Mehta ok, I’ll check it out, have the book on my shelf ;) let me know if any of the other videos are helpful

[@maenal-khashashneh5052]

Thanks , nice work But I think if 1gm of lipid equal 9kcal and with intralipid 10% the volume should be 700 ml . Please could you explain it if l'm wrong

[@shylajadeenadayalan605]

How is protein calculated ? Can u explain ?

[@layanmohsen1939]

in 17:07 , why are the dextrose grams divided by 2440 instead of 633 ml ?

[@citizensurgeon]

Remember that to find the percentage of a substance in a solution it’s the amount of that substance divided by the total volume of the solution. So in this case if the total volume is 2440 then the amount of dextrose in this volume will be the percentage of the solution. I hope that is clear!

[@kangumejustusamooti4915]

Self assessment questions

[@citizensurgeon]

Thank you for the suggestion, I'll have these put together and out shortly for each video!

[@kangumejustusamooti4915]

Do you have a PDFs for self assessment

[@citizensurgeon]

Working on it! What would be most helpful? Bullet points, questions, questions/explanations, etc?

[@kangumejustusamooti4915]

@@citizensurgeon Questions/explanations. You have a good explanation of the hard core content

[@citizensurgeon]

@@kangumejustusamooti4915 thanks so much that means a lot

[@lovchrib2481]

🎉🎉

[@citizensurgeon]

Thank you!

[@mrgfdrttr155]

Maybe my math is off, please correct me if so but towards the end isn't 110 ml/hr x 24 hrs ~ 2640 ml ?

[@citizensurgeon]

Ha! Dang! Thank you! That’s embarrassing, hopefully the concepts are clear :)

[@mrgfdrttr155]

@@citizensurgeon I learned more in this video than most textbook chapters have done for me so far. Absolute payoff thank you

[@citizensurgeon]

Thanks for the feedback and I’m sorry about the math error, I’m pumped that it was helpful for you! I’ll make a note in the description about the math. Good luck in your studies and if there is a topic you’d like to see let me know!

[@andresraulmalpartida]

If omega -6 suppresses immunity wouldn’t it be anti inflammatory instead of pro inflammatory ?

[@citizensurgeon]

It’s such a great and vexing question and the answer seems to be related to dietary omega six increasing the circulation of arachidonic acid which is proinflammatory. Check out this abstract… Inflammation is a normal process that is part of host defence and tissue healing. However, excessive or unresolved inflammation can lead to uncontrolled tissue damage, pathology and disease. In humans on a Western diet, the omega-6 polyunsaturated fatty acid arachidonic acid (ARA) makes a significant contribution to the fatty acids present in the membrane phospholipids of cells involved in inflammation. ARA is a precursor to a number of potent pro-inflammatory mediators including well described prostaglandins and leukotrienes, which has led to the development of anti-inflammatory pharmaceuticals that target the ARA pathway to successfully control inflammation. Hence, it is commonly believed that increasing dietary intake of the omega-6 fatty acids ARA or its precursor linoleic acid (LA) will increase inflammation. pubmed.ncbi.nlm.nih.gov/29610056/

[@iindiar]

it says "electroylte"

[@citizensurgeon]

Good catch!!

[@dramitnehra6758]

But Sir this patient is ICU , I mean the patient should be consider for more than 30 kcal/ kg Sir ????

[@citizensurgeon]

I talk about that, there are different energy requirements based on the severity of illness and the respiratory quotient, the patient may need 40kg/day, also important to recognize the possibility of over feeding

[@user-xk7vh6xm6q]

nutritionalists?