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Central Venous Catheter cuff exposed The central venous catheter dacron cuff is supposed to be underneath the skin, so it can hold the catheter firmly within tunnel. Here we see the catheter malpositioned with the dacron cuff externalized. Purulent discharge from CVC exit site Cellulitis around...

6 month-old male on home parenteral nutrition presents to emergency department with sudden onset altered mental status. On exam, patient is non-responsive, temperature 35 degrees Celsius, HR 180, blood pressure undetectable, skin is modeled. The central line site is clear. Blood cultures have been...

Patient is 13 year-old female unable to tolerate any enteral intake due to chronic small bowel obstruction and a history of heavy menses. For past 6 months, she complains of worsening fatigue and pallor. Hemaglobin is 8 (low), MCV 66 (low and previously normal). On exam, there is no tachycardia...

Patient is an 8 year-old female with HPN dependence due to short bowel syndrome. She has high ostomy due to proximal stoma. Height velocity gradually slows over the last 12 months. Receiving adequate calorie and fluid support. Compliance has been assessed to be satisfactory. On history, parents...

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...

Question 13. You are consulted as the HPN expert by the inpatient cardiology team to facilitate discharge for a 3 year-old female with a history of heart transplant for hypoplastic left heart syndrome was admitted for new onset 3-week history of vomiting, diarrhea and weight loss. Diagnostic...

Answer 13. The correct answer is b. Collaborate with medical, GI and nutrition team to facilitate completion of diagnostic work-up of feeding intolerance prior to formal HPN consultation. HPN involves intensive collaboration across disciplines and teams in the care of complex patients. The medical...

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...

Click here for an article on shortages affecting a HPN patient. Timeline Year Parenteral Nutrition Additive Response 2011 Selenium Multi-trace-5 (MTE-5) : standard dose 0.2 ml/kg/day, which provides: - Zinc: 200 mcg - Copper: 80mcg - Chromium: 0.8mcg - Manganese: 20mcg - Selenium: 4mcg Add Zinc to...