Who specifically needs a TPN?
- Patients with infections or problems in their pancreas, intestines (bowel), or other body organs
- Food tubes going into their stomach that cannot give them enough nutrition
- AIDS (acquired immunodeficiency syndrome)
- Some types of cancer
- Starvation or anorexia
- Serious burns
-
What is the difference between a TPN and a PPN (peripheral parenteral nutrition) ?
First of all a TPN and a PPN are used for the same cause which is to give the nutrition requirements that a patient needs. The difference is that a TPN must be given through a central venous catheter and the PPN may be given through a regular IV. Also TPN's are preferred nutritional supplement for a long time because it delivers through a central vein as for PPN's are only preferred partially because it is not safe to use hyperosmolar solutions in peripheral veins for a very long time. Also TPN comes in a higher concentration & it can only be administer through a large vein such as the chest or neck as for PPN comes in a lesser concentration that can be delivered through a peripheral vein.
EXTRA:
Sodium: Helps control water distribution and maintain a normal fluid balance
Potassium: Needed for cellular activity and tissue synthesis
Magnesium: Helps absorb carbohydrates and protein
Calcium: Needed for bone and teeth development also aids in clotting
Phosphate: Minimizes the threat of peripheral parenthesis
Chloride: Regulates the aid base equilibrium and maintains osmotic pressure
Acetate: Added to prevent metabolic parenthesis
Ascorbic acid: Helps in wound healing
Vitamin A: Maintaining integrity of skin and essential to vision
Vitamin D: Essential for bones and maintenance of serum calcium levels
Vitamin B complex: Helps in final absorption of carbohydrates and protein
Folic acid: DNA formation and promotes growth and development
Vitamin K: Helps prevent bleeding disorders
Trace elements: Help in wound healing and red blood cells synthesis
Interferon: May be added as a iron supplement
Insulin: Metabolize high glucose load
EX) You are preparing a TPN with 500ml of 7.5% Travasol and 500ml of 50% dextrose injection. What is the final % concentration of the Travasol and the dextrose in the TPN?
500ml X 0.075 (7.5% / 100) = 37.5% Travasol
500ml X 0.5 (50% / 100) = 250 / 100 = 2.5------<25%
Nutrition /nu·tri·tion/ (noo-trish´un) the taking in and metabolism of nutrients (food and other nourishing material) by an organism so that life is maintained and growth can take place.nutri´tional
enteral nutrition the delivery of nutrients in liquid form directly into the stomach, duodenum, or jejunum.
parenteral nutrition administration of nutriment intravenously.
total parenteral nutrition (TPN) intravenous administration, via a central venous catheter, of the total nutrient requirements of a patient with gastrointestinal dysfunction.
Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
Parenteral nutrition
Nutrition supplied intravenously, thus bypassing the patient's digestive tract entirely.
Mentioned in: Electrolyte Supplements, Necrotizing Enterocolitis
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
parenteral nutrition,
the administration of nutrients by a route other than the alimentary canal, such as subcutaneously, intravenously, intramuscularly, or intradermally. The nutrients, or parenteral fluids, usually consist of physiologic saline solution with glucose, amino acids, electrolytes, vitamins, and medications. They may not be nutritionally complete but maintain fluid and electrolyte balance during the immediate postoperative period and in other conditions, such as shock, coma, malnutrition, and chronic renal and hepatic failures. See also total parenteral nutrition.
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.
parenteral [pah-ren´ter-al]
by some route other than through the alimentary canal, such as by subcutaneous, intramuscular, intrasternal, or intravenous injection.
parenteral nutrition a technique for meeting a patient's nutritional needs by means of intravenous feedings; sometimes called hyperalimentation, even though it does not provide excessive amounts of nutrients. Nutrition by intravenous feeding may be either total parenteral nutrition or only supplemental.
Total parenteral nutrition provides all of the carbohydrates, proteins, fats, water, electrolytes, vitamins, and minerals needed for the building of tissue, expenditure of energy, and other physiologic activities. The procedure originated as an emergency life-saving technique following surgery for severe and massive trauma of the gastrointestinal tract but has now become a relatively common means of providing bowel rest and nutrition in a variety of conditions in spite of inherent risks. Although primarily used as a short-term temporary measure until either surgical or medical treatment corrects the gastrointestinal dysfunction, it has also been used with some success as a long-term therapy for selected patients on an outpatient basis.
Parenteral nutrition may be used in the following conditions: malnutrition from such acute and chronic inflammatory bowel diseases as regional ileitis (crohn's disease) and ulcerative colitis, partial or total obstruction of the gastrointestinal tract that cannot be relieved immediately by surgery, congenital anomalies in the newborn prior to surgery, massive burns that produce critical protein loss, and other disorders in which malnutrition is a threat to the life of the patient who cannot receive nutrients via the digestive tract.
The nutrient mix is tailored to the individual needs and tolerance of the patient. There is not complete agreement among the experts as to the ideal mix, especially of amino acids. The nutrient solutions usually are prepared in clean-air rooms in the pharmacy of a hospital under aseptic conditions to avoid contamination.
Administration of the nutrients is accomplished via a central venous catheter, usually inserted in the superior vena cava. The route of administration, constant rate of flow required, and potential patient sensitivity to the elements administered, all contribute to the potential complications of parenteral nutrition.
Of the many complications that may develop, the most common are febrile reactions arising from patient intolerance to the required rate of flow, reactions due to individual sensitivity to some of the elements in the nutrient mix, and infection from contamination of either the site of insertion of the catheter or the apparatus used to administer the nutrients. Other complications that may develop include phlebitis and thrombosis of the vena cava, electrolyte imbalance, hyperglycemia, cardiac overload, dehydration, metabolic acidosis, and mechanical trauma to the heart.
Total parenteral nutrition provides all of the carbohydrates, proteins, fats, water, electrolytes, vitamins, and minerals needed for the building of tissue, expenditure of energy, and other physiologic activities. The procedure originated as an emergency life-saving technique following surgery for severe and massive trauma of the gastrointestinal tract but has now become a relatively common means of providing bowel rest and nutrition in a variety of conditions in spite of inherent risks. Although primarily used as a short-term temporary measure until either surgical or medical treatment corrects the gastrointestinal dysfunction, it has also been used with some success as a long-term therapy for selected patients on an outpatient basis.
Parenteral nutrition may be used in the following conditions: malnutrition from such acute and chronic inflammatory bowel diseases as regional ileitis (crohn's disease) and ulcerative colitis, partial or total obstruction of the gastrointestinal tract that cannot be relieved immediately by surgery, congenital anomalies in the newborn prior to surgery, massive burns that produce critical protein loss, and other disorders in which malnutrition is a threat to the life of the patient who cannot receive nutrients via the digestive tract.
The nutrient mix is tailored to the individual needs and tolerance of the patient. There is not complete agreement among the experts as to the ideal mix, especially of amino acids. The nutrient solutions usually are prepared in clean-air rooms in the pharmacy of a hospital under aseptic conditions to avoid contamination.
Administration of the nutrients is accomplished via a central venous catheter, usually inserted in the superior vena cava. The route of administration, constant rate of flow required, and potential patient sensitivity to the elements administered, all contribute to the potential complications of parenteral nutrition.
Of the many complications that may develop, the most common are febrile reactions arising from patient intolerance to the required rate of flow, reactions due to individual sensitivity to some of the elements in the nutrient mix, and infection from contamination of either the site of insertion of the catheter or the apparatus used to administer the nutrients. Other complications that may develop include phlebitis and thrombosis of the vena cava, electrolyte imbalance, hyperglycemia, cardiac overload, dehydration, metabolic acidosis, and mechanical trauma to the heart.
Patient Care। Principles of strict aseptic technique must be followed in the daily changing of dressings and in handling the nutrient solution and the administration equipment. The catheter through which the nutrients are administered should not be used for administration of medication, blood, or any other substance that may induce clotting in the vein.
Superior vena cava administration of parenteral nutrition through a subclavian venous line. From Lammon et al., 1996.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
parenteral
adj literally, “aside from the gastrointestinal tract”; not through the alimentary canal (i.e., by subcutaneous, intramuscular, intravenous, or other nongastrointestinal route of administration).
parenteral nutrition,
n the administration of nutrients by a route other than the alimentary canal, such as subcutaneously, intravenously, intramuscularly, or intradermally. The parenteral fluid usually consists of physiologic saline with glucose, amino acids, electrolytes, vitamins, and medications, which are not nutritionally complete but maintain fluid and electrolyte balance.
Mosby's Dental Dictionary, 2nd edition. © 2008 Elsevier, Inc. All rights reserved.
nutrition
1. the sum of the processes involved in taking in nutriments and assimilating and utilizing them.
2. nutriment.
It includes all the processes by which the body uses food for energy, maintenance and growth. See also malnutrition, inanition, starvation, thirst, nutritional.
critical care nutrition
provision of nutritional support for patients in critical care units; usually requires modification of normal nutritional requirements to meet the demands of stress, injury and disease, and to support recovery from these states.
enteral nutrition
see enteral feeding.
intravenous nutrition
see parenteral nutrition (below).
nutrition Labeling and Education Act of 1990
an amendment to the (US) Federal Food, Drug, and Cosmetic Act which defines how foods, claimed to affect disease, are not regulated as drugs।
parenteral nutrition
a technique for meeting a patient's nutritional needs by means of intravenous feeding; sometimes called hyperalimentation, even though it does not provide excessive amounts of nutrients. Nutrition by intravenous feeding may be total parenteral nutrition (TPN) or supplemental. TPN provides all of the carbohydrates, proteins, fats, water, electrolytes, vitamins and minerals needed for the building of tissue, expenditure of energy, and other physiological activities.
total parenteral nutrition
called also TPN; see parenteral nutrition (above).
parenteral
not through the alimentary canal, e.g. by subcutaneous, intramuscular, intrasternal or intravenous injection, e.g. parenteral fluid therapy.
parenteral alimentation
see parenteral nutrition (below).
parenteral hyperalimentation
see parenteral nutrition (below).
parenteral nutrition
the provision of adequate carbohydrate, protein, vitamins, minerals and fluids parenterally to maintain the animal over a relatively long period of several weeks. Called also parenteral alimentation, parenteral hyperalimentation. See also parenteral nutrition.
parenteral therapy
treatment by the parenteral route is limited to those substances that are soluble in a solvent that can be injected into tissues including the bloodstream। The choice of routes may depend on the nature of the vehicle used, e.g. oily preparations are injected into tissues, irritant substances are injected intravenously slowly.
parenteral nutrition
IV feeding, parenteral alimentation The administration of nutrients parenterally, usually IV. See Total parenteral nutrition. Cf Forced feeding.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
Artificial nutrition is the delivery of a patient’s nutritional support in a fashion that does not require the patient to chew and swallow. This can be given with total parenteral nutrition (TPN), or through a nasogastric tube (NG tube) or gastrostromy tube (G tube or PEG tube)।
There are many things that can cause loss of appetite and reduced oral intake of food and fluids near the end of life. Some causes are reversible, such as constipation, nausea, and pain। Other causes may not be treated effectively, such as certain cancers, altered states of consciousness, and weakness of the muscles necessary to eat. Reversible causes should be identified by the patient’s physician and addressed. If the cause is unknown or not treatable, the decision whether to withhold or withdraw support may need to be made.
Making the decision to withhold or withdraw artificial nutrition and hydration raises intellectual, philosophical and emotional conflicts for many people। It is often helpful for people faced with that difficult decision to understand what science and medicine have found regarding artificial nutrition and hydration at the end of life.
The Benefits and Risks of Artificial Nutrition and Hydration
In our society and culture, food and fluids are viewed to be essential to sustain life and to speed healing and recovery from illness। It goes against most peoples values to withhold food and fluids from a critically ill or dying patient. Yet we all know that knowledge is power. As with any medical decision you are faced with, it is important to understand the benefits of risks. Is artificial nutrition beneficial for the terminally ill patient? Let’s take a look at what medical research can tell us:
- Total Parenteral Nutrition –TPN is an imperfect form of nutrition that is only used short term। It is delivered through a central line, which is usually inserted at the neck or armpit and threaded through a vein where it ends up near the heart। It was once thought that patients with cancer could benefit from TPN. The hope was that it could reverse the loss of appetite and severe weight loss that cancer patients suffer and improve their prognosis. However, several studies found that it neither helped cancer patients gain weight nor improve their quality of life. On the contrary, it actually increased the risk of infections and problems with the central line that were dangerous to the patients.
- Nasogastric (NG) Tubes – For patients who are unable to swallow, whether it’s due to invasive tumors, weakness, or neurological disorders, feeding through a tube has been the standard delivery of nutrition। The nasogastric tube is the easiest way to achieve this. A tube is inserted through the nose and down the throat into the stomach. A liquid food formula is given through the tube continuously at a slow rate or several times a day with a larger dose. Like TPN, however, multiple medical studies have shown that survival rates for terminally ill patients are no different if they are artificially fed rather than not. Again, the risks are dangerous. Patients with NG tubes have a higher risk of pneumonia which can significantly lower their survival rate. NG tubes can also be easily pulled out, causing distress to both the patient and their loved ones.
- Gastostomy (G) Tubes – A gastrostomy tube is one that inserted directly into the stomach by a surgical procedure। A percutaneous-endoscopic gastrostomy, or PEG tube, is done endoscopically and is less invasive. With either of these tubes there is less risk of the patient pulling the tube out. There is still the risk of pneumonia, however. Just like the nasogastric tube, there is little evidence that feeding through a gastrostomy tube will increase the health or life expectancy of terminally ill patients.
- Intravenous (IV) Hydration – If a patient can no longer drink fluids or isn’t drinking what his caregivers think is enough fluid, the caregiver may be tempted to ask for IV fluid. Fluids can be delivered through a small needle that is inserted in a vein and hooked up to tubing. Studies have shown that administering fluids to a terminally ill patient at the end of life offers little, if any, benefit. Risks include infection at the insertion site or in the blood, and fluid overload resulting in swelling or even breathing problems in more severe cases.
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601166.html
http://www.nutritioncare.org/WorkArea/showcontent.aspx?id=4534
TPN Calculator- http://www.globalrph.com/tpn.cgi
http://en.wikipedia.org/wiki/Total_parenteral_nutrition
http://jn.nutrition.org/search?fulltext=Tube+Feeding&submit=yes&x=0&y=0
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