TPN stands for Total Parenteral Nutrition. This a complete form of nutrition, containing protein, sugar, fat, added vitamins and minerals as needed for each individual. It is administered through an intavenous infusion, usually using a central line. A central line is a special long lasting IV line that goes through a vein directly to the heart. It is usually placed on the chest, though sometime if the location must be changes frequently it will be placed in other areas such as the groin or the neck.
TPN is a lifesaver for people who are unable to absorb adequate nutrition through their intestines. This can happen for a variety of reasons, Short Bowel syndrome (SBS), Chronic Intestinal Pseudo-obstruction (CIPS), Eosinophilic Gastroenteritis (EG), Hirshprungs and various other diseases or disorders. TPN is a miracle, in that it keeps people alive where they cannot eat to sustain themselves.
Severely malnourished patients who are being prepared for surgery, radiation therapy, or chemotherapy for cancer are given TPN before and after treatment to improve and maintain their nutritional status. In major surgery, severe burns, and multiple fractures, especially in the presence of sepsis, TPN reduces subsequent morbidity and mortality, promotes tissue repair and enhance the immune response. Prolonged coma and anorexia often require TPN after intensive enteral feeding in the early stages. Conditions requiring complete bowel rest (e.g.. some stages of Crohn's ulcerative colitis severe panereatitis) and pediatric Gl disorders (e.g congenital anomalies, protracted nonspecific diarrhea) often respond well to TPN.
TPN requires water (30 to 40 ml/kg/day) and energy (30 to 60 kcal/kg/day), depending on energy expenditure, and amino acids (1 to 3 g/kg/day), depending on the degree of catabolism. Basic TPN solutions are usually mage up in liter batches according to standard or modified formulas. A patient without hypermetabolism or server chronic disease requires 2 L of the standard formula per day or differing amounts of a modified formula. Lipid emulsions supplying essential fatty acids and triglycerides may be used in addition to a basic solution.
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Solutions must be prepared aseptically under a laminar-flow filtered-air hood. Insertion of a central venous catheter is never performed as an emergency and requires full aseptic conditions and adequate assistance. Subclavian placement is standard, using a Broviac or Hickman catheter. A point is selected just inside and below the midpoint of the clavicle, and the needle is inserted through the pectoralis muscle into the subclavian vein and then into the superior vena cava. A chest x-ray is always obtained after catheter insertion or position change to confirm the location of the tip. External tubing should be changed q 24 with the first bag of the day. In-line filters are not recommended. Special occlusive dressings are an essential part of catheter maintenance and are usually changed q 48 h with full aseptic and sterile precautions.
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| Precautions During Administration |
The solution is started slowly at 50% of the calculated patient requirements, making up the balance of fluid with 5% dextrose. Energy and nitrogen sources should be given simultaneously. the amount of regular insulin given (added directly to the TPN solution)depends on blood glucose estimations; if blood glucose is normal (fasting, 70 to 100 mg/dL.[3.89 to 6.10mmol/L]). the usual starting, dose is 5 to 10 u regular insulin/L TPM fluid containing 25% dextrose in the final concentration. Measure to prevent rebound hypoglycemia after discontinuing high concentrations of dextrose should be taken.
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A great variety are in common use. A lipid emulsion can be chosen and the exact pattern of electrolytes added can be tailored to meet the patient's needs. Patients with organ failure require specially modified formulations. Patients with renal or hepatic failure require formulations with a reduced amino acid content, those with heart failure require that volume (liquid) intake be limited, and those with respiratory failure require that most of the nonprotein calories be provided by a lipid emulsion to avoid increased CO2 Production. Children who need TPN also have special nutritional requirements.
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Ms. Rehana Islam
Tel : 111-334-111 (Ext: 443)
Dir: 6629251
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