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Use of TPN

If you have ever received dextrose through an IV, you have received partial parenteral nutrition. Total parenteral nutrition (TPN), on the other hand, is a balanced formula of nutrients that meets a patient's daily requirement of calories, amino acids, essential fatty acids, vitamins and minerals. However, TPN can cause severe complications and health care professionals carefully weigh alternatives to this treatment.

  1. Total Parenteral Nutrition

    • Not to be confused with parental, Stedman's Medical Dictionary defines parenteral as something "taken into the body or administered in a manner other than through the digestive tract." Conversely, enteral is defined as "within or by way of the intestine." Administered intravenously, TPN essentially bypasses the digestive tract and puts nutrients right into the bloodstream. The basic solution may need adjusting depending on underlying disorders, patient age or other factors that affect absorption or nutritional needs.

    Indications for TPN

    • Typically reserved for those patients whose intestinal system is not working correctly or at all, Georgetown University and Hospital uses TPN for those patients with conditions such as short bowel/gut syndrome, motility disorders (when food, for one reason or another, does not move through the intestines appropriately), or congenital abnormalities of the intestinal tract. There are also patients who require TPN for bowel rest due to complications from diseases such as Crohn's. Premature infants in critical care situations might also require TPN. Georgetown University estimates approximately 40,000 patients in the United States are on TPN chronically.

    Possible Side Effects/Complications

    • While TPN may be lifesaving in some cases, it does not come without risks. Merck and Company, a manufacturer of the TPN solution, notes that enteral feeding, even with use of a gastric tube, is preferred to TPN when possible. Those on TPN are at risk for infection of the catheter/central line used for administration. About 50 percent are at risk for catheter-related sepsis and approximately 90 percent for glucose abnormalities or liver dysfunction. Gallbladder disease and osteoporosis are among other possible complications.

    Monitoring

    • When a patient begins TPN in the hospital, Merck recommends monitoring weight, CBC, electrolytes and BUN daily. They advise checking blood glucose every six hours until the levels are stable. Doctors will also monitor liver function closely. The frequency of lab checks will decrease over time but will continue as long as the patient is on TPN. There are patients who eventually go home on TPN after receiving education regarding signs/symptoms of infection. In these cases, routine home visits by nursing staff are also required.

    Worth The Risk

    • The side effects and possible complications of TPN are concerning. However, according to Georgetown University Hospital, for those infants born with abnormalities like gastroschisis (gastro-skee-sis), when the intestines form outside the abdominal wall during gestation, or patients suffering from issues like short-gut syndrome, TPN is often the only option. With careful monitoring and supervision, it can keep a patient alive until further treatment such as intestinal transplant can be undertaken.

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