Assessing Energy needs upon admission to Acute Care Unit (ACU). Assessing Protein needs upon admission to ACU. Prescribing daily Calories and Protein goals. Assessing Vitamin and Mineral intake and supplementation.
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Role of Dietitian Utilizing the Standardization of Nutrition Practices
Presentation on theme: "Role of Dietitian Utilizing the Standardization of Nutrition Practices"— Presentation transcript:
Role of Dietitian
Utilizing the Standardization of Nutrition Practices Assessing Energy needs upon admission to Acute Care Unit (ACU)Assessing Protein needs upon admission to ACUPrescribing daily Calories and Protein goalsAssessing Vitamin and Mineral intake and supplementationEnsuring Glutamine and Arginine supplements are not givenOptimizing Enteral Nutrition DeliveryMonitoring & Recording Daily Nutritional AdequacySlide2
To reduce the effect of varying nutritional practices as confounding factors on the outcomes of The RE-ENERGIZE study, it is important to standardize (as much as possible) the following:
and Parenteral NutritionMicronutrient deliveryWithholding Feeds for High Gastric Residual Volumes We recommend compliance with the following nutritional practices. This will allow for most current practices to continue.
Standardization of Nutrition PracticesSlide3
1) Prescribed Energy Needs
Calculated by using :
Indirect Calorimetry, a predictive equation, or a simple weight-based formula
On average, this should not lead to a prescription of less than 30 kcal/kg WeightPre-burn dry weight should be used when calculating energy needs. For Obese patients, if your standard practice is to adjust for obesity, follow your standard practice. If you do not have an obesity adjustment practice, use the formula below.Adjusted Body Weight (ABW) = Ideal Body Weight (IBW) based on a BMI of 25 + [(pre-burn dry weight – IBW) x 0.25]Slide4
2) Prescribed Protein Needs
Calculated According to % burn surface area
If > 50% burns, use 1.5g/kg/day to 2.5g/kg/day
If < 50% burns, use 1.2g/kg/day to 2 gm/kg/day Pre-burn dry weight should be used when calculating protein needs. For Obese patients, if your standard practice is to adjust for obesity, follow your standard practice. If you do not have an obesity adjustment practice, use the formula below.Adjusted Body Weight (ABW) = IBW + [(pre-burn dry weight – IBW) x 0.25]
3) Vitamin & Mineral Prescription
Should be given as follows or depending upon blood levels (if blood testing is done as part of routine practice):
Early supplementation by high dose IV Vitamin C (66 mg/kg/hr) within the first 48 hrs is allowed. Standard multivitamin/mineral preparations are allowed (IV, NG or
).These ranges of vitamins/minerals/trace elements may be provided as supplementation over and beyond what is present in the standard enteral/parenteral nutrition.ORThese ranges of vitamins/minerals/trace elements may be
provided as the total amounts. This means that the amounts received from
nutrition are to be subtracted from the total ranges and the remainder is given as supplements.Slide7
4) Specialized nutritional formulas
are not allowed such as:
enriched formulas (formulas that contain >6gms arginine/L)Pivot ® (13 g/L) Perative ® (8 g/L) would not be allowed
Impact ® Glutamine (15 g/L)VIVONEX ® Plus (13.5 g/L)GLUTASOLVE ® (15 g/L) /other glutamine powdersJuven® (7 g/L)Formulas with glutamic acid inherently present are allowed
To minimize any potential contamination, patients that have received
glutamine for >24
before randomization, should NOT be included.Slide8
Optimization of the Delivery of Enteral Nutrition:
nutrition is preferred over parenteral nutrition Minimize interruptions to the delivery of EN – use strategies such as:Elevating the Head of the BedGastric residual volume threshold of 250 ml
Small bowel feeding tubes
Monitor EN volume delivery daily
Implement an action plan to ensure prescription is deliveredSlide9
Enteral Feeding Protocol
Nutrition as soon as possible after burn injury, preferably within 24 hrs of burn injury, if possibleElevate HOB to 45 degrees, if possible
If gastric feeding
, check GRVs q 4 hrs.
Is the GRV
Is this the 1
GRV > 250 ml*?
2) Continue with
1) Refeed GRV to
and discard the rest
10mg IV q 6 hrs
3) Continue with
This is a rechecked residual >250
1) Discard the residual
2) Continue with Motility agents3) Switch to SMALL BOWEL FEEDING 4) Restart Enteral Nutrition5) Monitor enteral nutrition tolerance, but do not monitor GRVs if small bowel feeding
* Gastric residual volume (GRV) of 250
is the minimum threshold volume. Volumes higher than 250
are acceptable if allowed at the individual site.
WATER FLUSHES:Flush tube with at least 10 mls of sterile water:-q4hrs during feedings-after aspiration for GRVs-before and after medsBLOCKED TUBE:Pancrealipase, 8000 units, with crushed Na Bicarb 500mg in 5ml warm water via feeding tube as needed.
nutrition if the patient develops :
) Glycemic control:Encourage the use of a
control protocol (or insulin) to:Avoid hyperglycemiaMinimize risk of iatrogenic hypoglycemiaMaintain glucose levels between the following ranges:
(min) to 180 mg/
/L (min) to 10
Recording Timing of Start and Stop of EN & PN
Dietitian will receive a copy of this formSlide12
Collect data as close to real time as possible so that action can be taken to ensure patient receives nutrition prescribed.
Dietitian will receive a copy of this formSlide13
MUST be collected according to calendar day as described aboveDo NOT collect data according to your flow sheet unless it runs from
Study Days and Data Collection
Study days are defined as follows and data
be collected according to study days:
Study Day 1 =
ACU admit date
(not randomization) and
until 23:59 the same day.
Study Day 2 = the subsequent day starting at 00:00 to 23:59 that day
A patient is admitted to the ACU on Sept 8th, 2015 at 4:00 PM (16:00). The study days would be: Study Day 1 = 2015-09-08 from 16:00 to 2015-09-08 at 23:59 Study Day 2 = 2015-09-09 from 00:00 to 2015-09-09 at 23:59 Slide14
Role of Dietitian Utilizing the Standardization of Nutrition Practices - Description
Assessing Energy needs upon admission to Acute Care Unit ACU Assessing Protein needs upon admission to ACU Prescribing daily Calories and Protein goals Assessing Vitamin and Mineral intake and supplementation ID: 683644 Download Presentation
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