Archive:Total parenteral nutrition

2006-12-09T02:27:21Z

68.35.231.8:

'''Total parenteral nutrition''' (TPN), is the practice of feeding a person intravenously, circumventing the [[gut]]. It 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 [[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 [[Hickman line]] or a [[Port-a-Cath]] (venous access systems). In infants, sometimes the [[umbilical artery]] is used.

Battery-powered ambulatory infusion pumps are used with chronic TPN patients, and usually the pump and a small (100 ml) bag of nutrient to keep the vein open are carried in a fanny pack. 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 a different fatty acid infusion (which is not approved for use in the U.S.) several patients were able to recover from their condition.

==See also==
* [[Intravenous drip]]

== External links ==
*[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://blogs.nutrishare.com TPN Blogs] on [http://www.Nutrishare.com Nutrishare] (a Home TPN provider)

[[Category:nutrition]]
[[Category:intensive care medicine]]

[[de:Parenterale Ernährung]]
[[nl:Parenterale voeding]]
[[ja:高カロリー輸液]]
[[pt:Nutrição parenteral]]

I failed the final at famu today
-np

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Archive:Total parenteral nutrition