TPN and Outpatient Heme/Onc

Dear All,
Friday and Monday presented unique days of learning in the field. I spent all of Friday with the TPN pharmacist. I loved gaining the insight into world of TPN. At WFUBMC, all formulas are made on site by a mechanically-operated compounder. Any percentage of amino acids, dextrose and fat can be used to create a custom formula. I observed as the compounder worked to add each ingredient to a bag. The room with the compounder is completely sterile and extreme precautions are taken to maintain that environment. After spending some time in the laboratory, I rounded with the pharmacist. We visited four patients. She said it normally varies how many people are on TPN at one time, but generally she receives several new consults each week. Basically we reviewed each person's medical chart and then reevaluated his or her status to determine if the formula should be changed. She paid particularly close attention to blood glucose control and fluid retention. If the percentages were changed for a patient, she would complete a form and send it to the pharmacy where new bags would be made from that point forward. The pharmacist said all patients are generally started on the "standard" formula. Then, after evaluating tolerance, the percentages are adjusted as needed.

Yesterday, I shadowed the outpatient cancer dietitian. She had a very outgoing, bright personality that seemed to lighten the gravity of each patient's situation. I loved how she had the opportunity to develop relationships with her patients and took full advantage of that situation. She primarily works with head and neck, pancreatic, and liver cancer patients. I was able to observe a few radiation treatment sessions, which was neat to see -- lots of large machines, silence, and stillness. The primary focus of the dietitian seemed to be maintaining the weight of the patients. Because so many people lose weight when treatment is initiated or even upon diagnosis, the dietitian works diligently to prevent significant weightloss. She made a point of saying that this is not always possible even when tubefeedings are initiated agressively.

Most of the patients who receive tubefeedings get a Mic-Key. I saw one on a patient. Kind of cool. The dietitian also ran through the education process she uses when educating patients receiving new mic-keys. She has physical examples of the device and its adapters and talks to the patients about feedings, flushings, and proper care. I learned a lot.

Hope all is well. More soon....
Rachael