Total parenteral nutrition (TPN) is intravenous administration of nutrients including carbohydrates, lipids, amino acids, electrolytes, vitamins and minerals to provide nutrition when oral or enteral nutrition is not possible. TPN can be administered either peripherally into small veins or centrally into large central veins and provides full nutritional requirements. TPN solutions must be prepared under sterile conditions and require careful monitoring during administration due to risks from catheter infections or electrolyte imbalances. TPN is used when the gastrointestinal tract cannot absorb adequate nutrients typically in conditions like cancer, pancreatitis, malnutrition or organ failure.

1. TOTAL PARENTRAL NUTRITION
PRESENTED BY:RIYA MARIAM
IV-PHARMD
HOSPITAL PHARMACY
6/26/2018 1

2. CONTENTS
 INTRODUCTION AND DEFINITION
 TYPES OF PARENTERAL NUTRITION
 REQUIREMENTS OF TPN
 MANUFACTURING OF TPN
 ADMINISTRATION
 LABELLING
 PHARMACEUTICAL USES
6/26/2018 2

3. INTRODUCTION:
Total parenteral nutrition (TPN) is a method that
bypasses the gastrointestinal tract, because of its
absorptive capacity is impaired. Fluids are given into a
vein to provide most of the nutrients the body needs.
DEFINITION: Total parenteral nutrition (TPN) is
intravenous administration of calories & other nutrients in
sufficient quantities to achieve tissue synthesis &
anabolism.
6/26/2018 3

4. 6/26/2018 4

5. TYPES OF TPN:
 CENTRAL PARENTERAL NUTRITION :
It is often called as total parenteral nutrition (TPN); delivered
into central vein. It includes lipids, vitamins, minerals, amino
acids (>5%), dextrose (>20%), & trace elements.
 PERIPHERAL PARENTERAL NUTRITION :
PPN is delivered into a smaller or peripheral vein. Total kcal
limited by concentration & ratio to volume being administered.
6/26/2018 5

6. TYPES:
CENTRAL PARENTRAL NUTRITION PERIPHERAL PARENTRAL NUTRITION
6/26/2018 6

7. REQUIREMENTS OF TPN:
Requirements of TPN include:
 Carbohydrates
 Lipids(fat)
 Amino acids
 Electrolytes
 Trace elements and Fluids
6/26/2018 7

8. • CARBOHYDRATES:
Eg- DEXTROSE
Carbohydrates is the main source of energy. The monohydrate form
of glucose is the primary source of carbohydrates used in TPN.
Others carbohydrates source such as fructose, galactose & sorbitol
should not be used as energy sources in TPN.
• LIPIDS (FAT):
• This is the primary source of essential fatty acid (linoleic acid) in
TPN. Linoleic acid is useful as precursors of prostaglandins & in the
synthesis of other fatty acids which are essential for cell membrane
integrity.
6/26/2018 8

9. ELECTROLYTES:
Sodium(Na) – 100 to 200 mEq
Potassium(K) – 80 to 120 mEq
Magnesium(mg) – 8 to 16 mEq
Calcium(Ca) – 5 to 10 mEq
Chloride(Cl) – 100 to 200 mEq
VITAMINS:
The daily requirement of both water soluble & fat soluble vitamins should be added to
TPN formulation. These vitamins are required for the metabolism of carbohydrates,
proteins, fats. Fat soluble vitamins are A, D, E & K. Water soluble vitamins are B1, B2 ,
B3 , B5 , B6 , B7 , B9 , B12, & C.
6/26/2018 9

10. ADMINISTRATION OF TPN:
• TPN is administered through a needle or catheter that is placed in a large
vein that goes directly to the heart called a central venous catheter.
• Since the central venous catheter needs to remain in place to prevent further
complications, TPN must be administered in a clean and sterile
.environment.
• For instance, external tubing should be changed everyday and dressings
should be kept sterile with replacement every two days.
• TPN is usually used for 10 to 12 hours a day, five to seven times a week.
• Most TPN patients administer the TPN infusion on a pump during the
night for 12-14 hours so that they are free of administering pumps during
the day.
• TPN can also be used in both the hospital or at home.
6/26/2018 10

11. LABELLING OF SOLUTIONS:
The prepared solution’s label should contain the following:
 Name of the drug
 Strength
 Instructions for use.
 Expiration date The prepared solution is good for 24 hours
(stability) and it is to be kept in the refrigerator until the time of
use.
 TPN solutions should not be mixed with other intravenous
solutions (separate lines should be used), unless it is discussed
with the pharmacist to determine compatibility.
6/26/2018 11

12. 6/26/2018 12

13. PHARMACEUTICAL USES:
 Inability to absorb nutrients via the gastrointestinal tract.
 Cancer – antineoplastic therapy, radiation therapy, bone marrow
transplantation.
 Moderate to serve pancreatitis when adequate enteral intake is not expected
for 5 to 7 days.
 Serve malnutrition with a temporary nonfunctional gastrointestinal tract.
 Critical care situations.
 Organ failures – liver, renal, respiratory.
 Hyper emesis.
 Eating disorder.
6/26/2018 13

14. INGREDIENTS:
S.No PARAMETER NORMAL RANGE
1. Total kilo calorie / day 25-30 k.cal/kg
2. Protein requirement 0.8-2 gm/kg
3. Dextrose 3-5 mg/kg/min
4. Fat emulsion 10,20,30 %
5. Fluid 2.5 lit-3.5 lit
6. Sodium 1-2 m.eq/kg
7. Potassium 1-2 m.eq/kg
8. Calcium 10-15 m.eq/kg
9. Magnesium 8-20 m.eq
10. Phosphorous 10,20-40 m.moles
11. Trace element 3-5ml6/26/2018 14

15. REFERENCES:
 N. Narayanan & S. Balasubramanian; Hospital &
Clinical pharmacy; 2nd Edition; pg.no:-106 to 113.
 D. Sudheer Kumar, J. Krishnaveni, P. Manjula;
Fundamentals of clinical pharmacy practice; 1st Edition
(reprint); pg.no:- 280 to 309.
 K. Ravi Shankar & G.V.N. Kiranmayi; Clinical pharmacy
& Pharmacotherapeutics; 1st Edition; pg.no:- 58 to 67.
https://www.moh.gov.sa/depts/Pharmacy/Documents/Tota
l%20Parenteral%20Nutrition%20(TPN).pdf
6/26/2018 15

16. THANKYOU
6/26/2018 16