Archive:Total parenteral nutrition

2007-10-02T01:54:36Z

66.171.164.27: /* General Usage */

[[Image:Tpn_3bag.jpg|thumb|Home TPN formula]]

'''Total parenteral nutrition''' (TPN), is the practice of feeding a person [[intravenous]]ly, bypassing the usual process of [[eating]] and [[digestion]]. The person receives nutritional formulas containing [[salt]]s, [[glucose]], [[amino acid]]s, [[lipid]]s and added [[vitamin]]s.

==General Usage==

TPN is normally used following surgery, when feeding by mouth or using the [[gut]] is not possible, when a person's digestive system cannot absorb nutrients due to [[chronic (medicine)|chronic disease]], or, alternatively, if a person's nutrient requirement cannot be met by [[enteral feeding]] (tube feeding) and supplementation. It has been used for [[Coma|comatose]] patients, although enteral feeding is usually preferable, and less prone to complications. Short-term TPN may be used if a person's digestive system has shut down (for instance by [[Peritonitis]]), and they are at a low enough weight to cause concerns about nutrition during an extended hospital stay. Long-term TPN is occasionally used to treat people suffering the extended consequences of an accident or surgery. Most controversially, TPN has extended the life of a small number of children born with nonexistent or severely birth-deformed guts. The oldest were eight years old in [[2003]].

The preferred method of delivering TPN is with a medical [[infusion pump]]. A [[sterilization (microbiology)|sterile]] bag of nutrient solution, between 500 mL and 4 L is provided. The pump infuses a small amount (0.1 to 10 mL/hr) continuously in order to keep the vein open. Feeding schedules vary, but one common regimen ramps up the nutrition over a few hours, levels off the rate for a few hours, and then ramps it down over a few more hours, in order to simulate a normal set of meal times.

The nutrient solution consists of [[water]], [[glucose]], [[salt]]s, [[amino acid]]s, [[vitamin]]s and (more controversially) sometimes emulsified [[fat]]s. Long term TPN patients sometimes suffer from lack of trace nutrients or [[electrolyte]] imbalances. Because increased [[blood sugar]] commonly occurs with TPN, [[insulin]] may also be added to the infusion. Occasionally, other drugs are added as well.

Chronic TPN is performed through a central intravenous catheter, usually in the subclavian or jugular vein. Another common practice is to use a [[PICC line]], which originates in the arm, and exends to one of the central veins, such as the subclavian. In infants, sometimes the [[umbilical vein]] is used.

Battery-powered ambulatory infusion pumps can be used with chronic TPN patients. Usually the pump and a small (100 ml) bag of nutrient (to keep the vein open) are carried in a small bag around the waist or on the shoulder. Outpatient TPN practices are still being refined.

Aside from their dependence on a pump, chronic TPN patients live quite normal lives.

==Complications==

The most common complication of TPN use is bacterial infection, usually due to the increased infection risk from having an indwelling [[central venous catheter]]. [[Liver]] [[Liver failure|failure]] may sometimes occur; a recent study at Children's Hospital Boston on the cause suggests it is due to a large difference in omega-6 to omega-3 ratio. When treated with [[Omegaven]], a different fatty acid infusion (which is approved for limited use in the U.S.), two patients were able to recover from their condition.<ref>[http://pediatrics.aappublications.org/cgi/content/full/118/1/e197?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=parenteral+nutrition&searchid=1&FIRSTINDEX=0&volume=118&issue=1&resourcetype=HWCIT| Gura KM, Duggan CP, Collier SB, et al. Reversal of parenteral nutrition-associated liver disease in two infants with short bowel syndrome using parenteral fish oil: implications for future management. ''Pediatrics'' Vol. 118 No. 1 July 2006 p197-201]</ref>

Two related common complications of TPN are [[venous thrombosis]] and [[priapism]]. Fat infusion during TPN is assumed to contribute to both.<ref>[http://jpen.aspenjournals.org/cgi/content/abstract/16/2/171| X Hebuterne, AM Frere, J Bayle, and P Rampal Priapism in a patient treated with total parenteral nutrition ''Journal of Parenteral and Enteral Nutrition'' Vol. 16 No. 2 1992 p171-174]</ref>

Another complication of TPN is non-anion gap [[metabolic acidosis]].

==See also==
* [[Intravenous drip]]
* [[Parenteral and Enteral Nutrition]]

==References==
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== External links ==
*[http://www.nutritioncare.org American Society for Parenteral and Enteral Nutrition]
*[http://www.heinrick.com/ryan/tpn.cfm TPN/PPN Calculator] by Ryan Heinrick
*[http://www.childrenshospital.org/newsroom/Site1339/mainpageS1339P1sublevel222.html "Why does prolonged TPN cause liver damage in infants?"], Children's Hospital Boston
*[http://grey.colorado.edu/shortgut/index.php/TPN-associated_Liver_Disease TPN-associated Liver Disease]
*[http://blogs.nutrishare.com TPN Blogs] on [http://www.Nutrishare.com Nutrishare] (a Home TPN provider)
*[http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601166.html TPN Drug Information] from MedlinePlus NIH Database
*[http://www.worldhealthlibrary.com/uncategorized/tpn-site-care/ TPN Care] from the World Health Library
[[Category:nutrition]]
[[Category:intensive care medicine]]

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[[pt:Nutrição parenteral]]

RecoveredNS112:Alumni services

2006-09-27T10:33:40Z

66.171.64.115:

Alumni services are important because it creates a circle of power. People graduate from the university and then they get into positions of power. These gets the university social networks and money.

The important thing about wikiversity is to make people feel like they *belong* to a community of people.

[[User:Roadrunner|Roadrunner]] 06:42, 7 August 2006 (UTC)

[[Category:Page moved from Wikibooks|{{PAGENAME}}]]

:How can facilitate networking? Do we want to go for the social networking approach? Once a course or topic garners enough interest, we should give it an IRC channel, and schedule regular meetings.

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Archive:Total parenteral nutrition

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