Total Parenteral Nutrition (TPN)

Administration of a nutritionally adequate solution through a catheter directly into the blood stream. This method bipasses the gastrointestial tract providing only the nutritional basics – typically dextrose, amino acids, essential vitamins and mineral components.

Indications: TPN may be the only feasible option for patients who do not have a functioning GI tract or who have disorders requiring complete bowel rest, such as the following:

  • In cases of severe exacerbations of Crohn’s disease or ulcerative colitis
  • Bowel obstruction
  • Certain pediatric GI disorders (eg, congenital GI anomalies, prolonged diarrhea regardless of its cause)
  • Short bowel syndrome due to surgery
  • In cases where the gastrointestinal tract requires respite to heal after trauma.

Administration technique:

Through a central venous catheter. 

The catheter and the skin around the catheter must cared for using sterile technique.

 The central line catheter may have 2-3 ports.  The TPN line should not be used for any other purpose.

External tubing should be changed q 24 h with the first bag of the day. In-line filters have not been shown to decrease complications.

Dressings should be kept sterile and are usually changed q 48 h using strict sterile techniques.

Assessments:

  • Weight
  • CBC
  • electrolytes
  • BUN
  • Plasma glucose should be monitored q 6 h until patients and glucose levels become stable.
  • Fluid intake and output should be monitored continuously.
  • Liver function tests.
  •  Plasma proteins (eg, serum albumin, possibly transthyretin or retinol-binding protein)
  • prothrombin time
  • plasma
  • urine osmolality
  • Ca
  • Mg
  • phosphate
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