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Question 10. 5 year-old male with long-term HPN dependence secondary to short bowel syndrome is seen for routine follow-up. Enteral tolerance is currently maximized. PN currently providing energy 45 kcal/kg/day, protein 1.3 gram/kg/day, IV soybean lipids 1 gram/kg/day, glucose infusion rate 10 mg/kg...

The parent of an 8 year-old female with chronic parenteral nutrition dependence secondary to chronic intestinal pseudo-obstruction calls with leaking at right upper extremity peripherally inserted central catheter (PICC) within 2 hours of nightly infusion. What is the first thing to recommend to...

5 year-old female with HPN dependence secondary to meconium pseudo-cyst develops acute agitation, headaches and vomiting immediately upon infusing HPN, which is a new batch from that was delivered yesterday. Of note, there have been no recent HPN prescription changes. Patient lives with parents in a...

Patient is a 16 year-old male chronic parenteral nutrition dependence secondary to short bowel syndrome secondary to atresia. Despite several intestinal lengthening procedures at your center, he continues to receive the vast majority of his nutrition intravenously. Family complains that frequent in...

Family notices there is something unusual about the appearance of their child’s central line (see photo below). The line is functioning fine. There is no leaking. The patient is asymptomatic. What is the problem? A. Outer lumen fracture B. Inner lumen fracture C. Central line thrombus D. Central...

During a dressing change, the parents note the central line exit site looks different (see photo below). What is the problem? A. Central venous catheter cuff exposed B. Cellulitis at central line exit site C. Eczema at central venous catheter exit site D. Central line exit-site and tunnel infection...

During a dressing change, the parents note the central line exit site looks different (see photo below). What is the problem? A. Central venous catheter cuff exposed B. Cellulitis at central line exit site C. Eczema at central venous catheter exit site D. Central line exit-site and tunnel infection...

A 25 year-old patient with a Port-a-Cath implanted in the right chest complains of sudden onset severe neck pain and headaches with flushing central line and PN infusions. Labs and exam normal, including afebrile. Previous X-ray shows central line tip in at the cavo-atrial junction. Today, chest X...