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TPN 1 Updated

Total parenteral nutrition (TPN) involves intravenous administration of nutrients, including glucose, protein, minerals, fats and vitamins, to provide nutrition when oral or enteral feeding is not possible. TPN is indicated for patients with short bowel syndrome, intestinal atresia, liver/pancreatic damage, or those requiring long-term ventilation or bone marrow transplants. TPN solutions are administered through central venous catheters or peripherally inserted central catheters. Close monitoring of fluid balance, glucose levels, electrolytes and other lab values is required to detect and manage complications of TPN such as infection, thrombosis, or metabolic imbalances.

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93 views13 pages

TPN 1 Updated

Total parenteral nutrition (TPN) involves intravenous administration of nutrients, including glucose, protein, minerals, fats and vitamins, to provide nutrition when oral or enteral feeding is not possible. TPN is indicated for patients with short bowel syndrome, intestinal atresia, liver/pancreatic damage, or those requiring long-term ventilation or bone marrow transplants. TPN solutions are administered through central venous catheters or peripherally inserted central catheters. Close monitoring of fluid balance, glucose levels, electrolytes and other lab values is required to detect and manage complications of TPN such as infection, thrombosis, or metabolic imbalances.

Uploaded by

athijasafraan1997
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TOTAL PARENTERAL NUTRITION (TPN)

OBJECTIVES
1. Definition
2. Indications for TPN administration
3. Composition of TPN solutions
4. Access routes for TPN administration
5. Monitoring TPN administration
6. Complications of TPN
7. Documentation
DEFINITION OF PARENTERAL
NUTRITION
• Parenteral nutrition is intravenous
administration of nutrition or method of
feeding that bypasses the gastrointestinal
tract.
• Fluids are given into a vein to provide most
of the nutrients the body needs.
INDICATIONS

SHORT BOWEL SYNDROME INTESTINAL ATRESIA LIVER/PANCREATIC


DAMAGE

BONE MARROW
LARGE GI SURGERIES LONG TERM VENTILATED PT
TRANSPLANT
CONTRAINDICATIONS
Where gastrointestinal feeding is possible.
 Patients with good nutritional status in whom only short term TPN support is antici-
pated.
Irreversibly decerebrate patients.
Lack of specific therapeutic goal: TPN should NOT be used to prolong life if death is in-
evitable .
Severe cardiovascular instability or metabolic derangements.

 Infants with less than 8 cm of small bowel


TYPES

• Central parenteral infusion

• Peripheral parenteral infusion


DIFFERENCE

Central Venous Catheters Peripheral parenteral infusion


• The subclavian or internal • Peripherally Inserted
jugular vein is catheterized Central Catheters
osmolarity:greater than (PICC)
900 mosmol/kg • Inserted into the basilic or
cephalic
osmolarity: Less than 600 to 900
mosm/kg
REFEEDING SYNDROME

Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes
that may occur in malnourished patients receiving artificial refeeding (whether enterally
or parenterally).

 Consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to


patients who are starved, severely malnourished or metabolically stressed due to severe
illness.

When too much food and/or liquid nutrition supplement is consumed during the initial four
to seven days of refeeding this triggers synthesis of glycogen, fat and protein in cells, to
the detriment of serum concentrations of potassium, magnesium and phosphorus.
MONITORING
• Regular monitoring is essential to detect and minimize complications and determine
response to nutritional support.
• Patients receiving Total Parenteral Nutrition should have their nutritional requirements
reviewed regularly, taking into account clinical condition, treatments (eg. dialysis) .
Fluid balance Monitor daily
Glucose tolerance Initially levels checked every 4-6 hours;
daily when stable
Venous access Venous access site regularly checked for
signs of infection, phlebitis

Serum Na, K, urea and Creatinine , Ca,


Routine biochemistry Mg, P, elements zinc, copper, Vitamins
B12, Folate, Vitamin A, Vitamin E.
TPN ADMINISTRATION PRACTICE
GUIDELINES
• Always infuse TPN with an infusion
pump
• Change TPN tubing every 24 hours
(daily at 1400)
• Monitor for signs & symptoms of
complications
COMPLICATIONS
MECHANICAL COMPLICATIONS
• Mechanical pneumothorax
• Malposition
• Embolism
• Infectious sepsis
• Thrombophlebitis
NUTRITIONAL COMPLICATIONS
• Fluid overload/dehydration
• Electrolyte imbalance
• Hyperglycaemia/ hypoglycaemia
• Nutrient deficiency
• Refeeding syndrome
SUMMARY
• TPN is ordered to meet nutritional needs
• Hypertonic IV solution consisting of glucose,
• protein, minerals, fats and vitamins given
• intravenously
• Peripheral, CVC, PICC preferred
• Monitor body’s metabolic status- glucometer,
CONCLUSION
• Total Parenteral Nutrition is expensive
• Only when enteral feeding is not possible/ sufficient , then only Total Parenteral
Nutrition is encouraged
• Enteral feeding is the best
• Nothing should be added into Total Parenteral bag
• Allow a separate port for Total Parenteral Nutrition
• Label the bag with starting time , date & flow rates

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