a brief informative ppt about total parental nutrition

2. It is the feeding of a person intravenously, by
passing the usual process of eating and digestion.
The person receives nutritional formulae that
contains nutrients such as glucose, salts, amino
acids, lipids and
added vitamins and
dietary minerals. It is
called topical parenteral nutrition(TPN) or total
nutrient admixture(TNA).

3. Total parenteral nutrition (TPN) is provided when the
gastrointestinal tract is nonfunctional because of an
interruption in it`s continuity or because its
absorptive capacity is impaired. It has been used for
comatose patients, although enteral feeding is
usually preferable and less prone to complications.
Parenteral nutrition is used to prevent malnutrition in
patients who are unable to obtain adequate nutrients
by oral or enteral routes. Two of main conditions
when it is used are: *Gastrointestinal disorders
*Cancer

4. TPN may be the only feasible option for
providing nutrition to patient who do not have a
functioning gastrointestinal tract or who have
disorders requiring complete bowel rest,
including bowel obstruction, short bowel
syndrome, gastroschisis, prolonged diarrhea
regardless of its cause, high output fistula,
severe Chron`s disease or ulcerative colitis
and certain pediatric GI disorders including
congenital GI anomalies and necrotizing
enterocolitis.

5. The benefit of TPN to cancer patients is largely
debated, and studies to date have generally
showed minimal long term benefit. On the
other hand there is no evidence to support the
idea that intravascular nutrition “feeds the
cancer, not the patient”.

6. TPN fully bypasses the GI tract and normal methods of nutrient
absorption. Possible complications which may be significantly are
listed below-
a. Infection: It is a common cause of death in the patients with a
mortality rate approximately 15%.
b. Blood clots: Chronic IV leaves a foreign body in the vascular
system and causes blood clots causing block in blood flow.
c. Fatty liver / liver failure: It`s a more long term complication.
The pathogenesis is due to using linoleic acid as major source
of calories.
d. Gut atropy: Infants who are sustained on TPN without food by
mouth by prolonged time periods are at risk for developing it.
e. Others: There are much more complications such as
cholecystitis, hypokalemia, hypophosphatemia, etc.

7. Substances Normal patient High stress Fluid restricted
Amino acid 85g 128g 75g
Dextrose 250g 350g 250g
Lipids 100g 100g 50g
Na 150meEq 155mEq 880mEq
K 80meEq 80mEq 40mEq
Ca 360mg 360mg 180mg
Mg 240mg 240mg 120mg
Acetate 72Meq 226mEq 134mEq
Cl 143mEq 145mEq 70mEq
P 310mg 465mg 233mg
MVI-12 10ml 10ml 1oml
Trace elements 5ml 5ml 5ml

8.  Collect supplies, prepare TPN solution and
drive IV tubing with filter as per agency protocol.
TPN requires special IV tubing with a filter.
 Complete all safety checks.
 Flush and disinfect Lumens.
 Insert TPN solution.
 Start TPN infusion.
 Complete daily assessments and monitoring for
patient on TPN as per agency policy.

9.  Assess indications of and risks for protein-calorie
malnutrition.
 Inspect condition of Central Vein assess site.
 Asses vital signs, auscultate patient`s lung sounds
and measure weight.
 Consult with physician and dietitian on calculation
of calorie, protein and fluid requirements for
proteins.
 Verify physician`s order for nutrients, minerals,
vitamins, trace elements, electrolytes and added
medications as well as flow rate. Check for
compatibility of added medications.

10. TPN is a process to provide patient`s
necessary nutrient parenterally. This process is
very useful and has a great usefulness in the
medical field, specially in the case of
unconscious, comma, oral
surgery/complication patients. Even though it
has disadvantages but still it`s widely
worldwide accepted for it`s vast benefits.