RE: [Critical Care Nutrition] Digest for criticalcarenutrition@googlegroups.com - 2 updates in 2 topics
MacEachern, Judy
Margot - Re: GRV - we never check them routinely (hasn't been our practice in > 15 y)
Karen - Re: ND tubes and free water. I wonder if the reference to 150 mL free water was based on that old case report (>10 y ago) where large boluses of distilled water were administered in a jejunally fed burn patient? We give 150-200 mL boluses of sterile water for the treatment of hypernatremia in stable ICU patient (i.e., not hypernatremia that may occur during fluid resuscitation from HONK/HHS or DKA).
Judy MacEachern RD CDE
Guelph General Hospital
From: criticalca...@googlegroups.com
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Sent: Wednesday, March 30, 2016 1:10 AM
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Subject: [Critical Care Nutrition] Digest for criticalca...@googlegroups.com - 2 updates in 2 topics
· Digest for criticalca...@googlegroups.com - 1 update in 1 topic - 1 Update
· Free water boluses via naso-duodenal Feeding tubes - 1 Update
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violam <vio...@kgh.kari.net>: Mar 17 09:31AM -0700
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KAREN <tuf...@msn.com>: Mar 29 12:39PM
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KAREN
Thanks for your response Judy, I think my question is should there by a volume limit to the amount of bolus given at one time into the duodenum? The docs are ordering 400 c.c. boluses, which seems to me like too much at once. Thanks, Karen
Sent: Wednesday, March 30, 2016 12:27:36 PM
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Subject: RE: [Critical Care Nutrition] Digest for criticalca...@googlegroups.com - 2 updates in 2 topics
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Luciana Sutanto
Drover, Dr. John W.
Hi Karen,
I am not aware of good data to identify what the maximum volume of a bolus that can be safely delivered into the SB. It would be modified by how quickly it is delivered. I have not qualms about delivering 250ml as a push would probably be OK with volumes up to 500ml delivered over an hour but that is just comfort, not evidence. Perhaps you could generate the empiric evidence of safety by monitoring the volume of boluses given and any complications experienced.
Cheers
John W. Drover, MD, FRCSC, FACS, CCPE
Professor and Head
Department of Critical Care Medicine
Queen’s University
Program Medical Director, Critical Care Program
Davies 2
Kingston General Hospital
76 Stuart Street
Kingston, Ontario
Canada
K7L 2V7
Phone 613-549-6666 ext 6335
Fax 613-548-1325
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KAREN
Thank you Lucy and Dr. Drover!
Sent: Sunday, April 3, 2016 11:34 PM