Being told that you or a loved one need Total Parenteral Nutrition (TPN) can be a source of stress. TPN is designed to bypass the eating and digestive processes to bring nutrients directly to the bloodstream using intravenous nutrition feeding.
TPN can be administered to patients of all ages, including children. In the media and movies, IV nutrition is typically seen administered to comatose patients. However, there are many other scenarios in which a patient may require TPN.
What is Total Parenteral Nutrition?
TPN is the administration of nutrition through an IV method, ensuring nutrition enters the body through the veins rather than the traditional feeding method. Patients with TPN can receive a variety of nutrients, typically including protein, fat, minerals, carbohydrates, electrolytes, and vitamins. TPN solutions are customized to individual requirements, based on health data, patient's age, organ functions, etc.
Total Parenteral Nutrition must be administered in a fully sterile and clean environment using a central venous catheter — a needle or catheter placed into one of the large veins going to the heart. The central venous catheter remains in place. Patients on TPN receive IV feeding 5 to 7 days a week, for 10 to 12 hours each time, either during daytime or nighttime.
Who Needs TPN Feeding?
Parenteral Nutrition is designed to bypass the digestive system. Doctors recommend it for patients who don't have a functional gastrointestinal tract, either because the absorbing ability is compromised or because the tract is interrupted. It can also be used when complete bowel rest is required. Diseases that may require TPN include:
- Short bowel syndrome
- Gastrointestinal bleeding
- Small bowel obstruction
- Extremely severe Crohn's disease
- Congenital gastrointestinal anomalies
- Cardiac and renal impairment
- Acute pancreatitis
Some patients may require TPN for different periods of time, ranging from temporary IV nutrition feeding to lifetime PN requirements. According to the American Society for Parenteral and Enteral Nutrition, approximately 25,000 patients receive parenteral nutrition at home.
| What TPN provides | Detail |
|---|---|
| Complete nutrition | Calories, protein, fats, vitamins, and minerals given through a vein |
| When it's used | When the gut can't absorb enough nutrition |
| Ongoing monitoring | Regular labs keep the formula and your electrolytes balanced |
How is TPN Managed?
The TPN ingredients are carefully selected to meet each patient's individual nutrition needs. A patient with kidney disorder is likely to receive less liquid in the TPN to prevent buildup in the bloodstream. On the other hand, some medical conditions, such as respiratory failure, will require a higher volume of liquid intake.
Administration in a Medical Environment
The patient's progress is monitored closely by a medical and nutrition team, who are responsible for:
- Safe storage of TPN doses
- Preparation of each dose
- Customizing dose ingredients based on lab results
- Monitoring of nutrition and other health levels related to the patient's condition
- Sanitizing and sterilizing the central venous catheter, feeding tubes, and surrounding areas
TPN Management at Home
For home TPN administration, the patient and medical team must work hand-in-hand. Doctors work in conjunction with a home infusion company and lab results to ensure TPN doses are adapted to the nutrition requirements of each patient.
A patient receiving TPN at home is under constant monitoring of an interdisciplinary nutrition and medical team that takes frequent measurements of:
- Patient's weight and BMI
- Electrolytes levels
- Complete blood count: white blood cells, red blood cells, blood platelets
- Liver function tests
- Nutritional assessments
- Other medical tests relevant to the patient's health condition(s)
Patients also receive the support of a qualified home nurse and become responsible for:
- Safe storage
- Safe and sterile administration
- Management of other food intakes throughout the day
- Keeping up-to-date with essential tests
Without appropriate follow-up and monitoring, patients with TPN could develop serious health complications, such as liver dysfunction, glucose anomalies, and catheter-induced sepsis.