TPN must be administered using an EID (IV pump), and requires special IV filter tubing (see Figure 8.10) for the amino acids and lipid emulsion to reduce the risk of particles entering the patient. TPN is not compatible with any other type of IV solution or medication and must be administered by itself. Figure 8.9 Types of TPN (amino acids and lipids) Figure 8.10 TPN tubing with special filter TPN is prepared by a pharmacy, where the calories are calculated using a formula, and is usually mixed for a 24-hour continuous infusion to prevent vascular trauma and metabolic instability (North York Hospital, 2013). TPN orders should be reviewed each day, so that changes in electrolytes or the acid-base balance can be addressed appropriately without wasting costly TPN solutions (Chowdary & Reddy, 2010). It is then called 3 in 1 or total nutrition admixture (Perry et al., 2014). At times, the lipid emulsion may be added to the amino acid/dextrose solution. Lipid emulsions are prepared in 100 to 250 ml bags or glass bottles and contain the essential fatty acids that are milky in appearance. The amino acid/dextrose solution is reviewed and adjusted each day based on the patient’s blood work. The ingredients listed on the bag must be confirmed by the health care provider hanging the IV bag. The solution may also include medication, such as insulin and heparin. It is often yellow in colour due to the multivitamins it contains. The amino acid/dextrose solution is usually in a large volume bag (1,000 to 2,000 ml), and can be standard or custom-made. It is ordered by a physician, in consultation with a dietitian, depending on the patient’s metabolic needs, clinical history, and blood work. TPN is made up of two components: amino acid/dextrose solution and a lipid emulsion solution (see Figure 8.9). Patients in hyperbolic states, such as burns, sepsis, or trauma.Patients with chronic or extreme malnutrition, or chronic diarrhea or vomiting with a need for surgery or chemotherapy.According to Chowdary & Reddy (2010), candidates for TPN are:īabies with an immature gastrointestinal system or congenital malformations Central veins are usually the veins of choice because there is less risk of thrombophlebitis and vessel damage (Chowdary & Reddy, 2010). TPN may be administered as peripheral parenteral nutrition (PPN) or via a central line, depending on the components and osmolality. The caloric requirements of each patient are individualized according to the degree of stress, organ failure, and percentage of ideal body weight. TPN is used with patients who cannot orally ingest or digest nutrition (Triantafillidis & Papalois, 2014). TPN may be short-term or long-term nutritional therapy, and may be administered on acute medical floors as well as in critical care areas. It aims to prevent and restore nutritional deficits, allowing bowel rest while supplying adequate caloric intake and essential nutrients, and removing antigenic mucosal stimuli (Perry et al., 2014).
TPN administers proteins, carbohydrates, fats, vitamins, and minerals. Total parenteral nutrition (TPN), also known as parenteral nutrition (PN) is a form of nutritional support given completely via the bloodstream, intravenously with an IV pump.
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