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
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.
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.
- 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
- urine osmolality