From the Guidelines
Total Parenteral Nutrition (TPN) should be considered for patients who cannot eat or absorb nutrients through their digestive system, with careful monitoring of potential complications and gradual tapering when transitioning back to enteral feeding. When considering TPN, it is essential to understand that parenteral nutrition can be categorized as total (or exclusive) PN, where it meets the patient's nutritional needs in entirety, and supplemental (partial or complementary) PN, where nutrition is also provided via the oral or enteral route 1. The primary life-saving therapy for patients with chronic intestinal failure (CIF) due to either benign or malignant diseases is Home Parenteral Nutrition (HPN) 1. Some key points to consider when administering TPN include:
- TPN is typically administered through a central venous catheter and contains a carefully balanced mixture of carbohydrates, proteins, fats, electrolytes, vitamins, and trace elements.
- Standard adult TPN formulations typically provide 25-35 kcal/kg/day with 1.2-2 g/kg/day of protein, though requirements vary based on the patient's condition.
- Potential complications include catheter-related infections, metabolic disturbances, liver dysfunction, and refeeding syndrome.
- Regular monitoring of blood glucose, electrolytes, liver function tests, and nutritional parameters is essential during TPN administration.
- TPN should be gradually tapered rather than abruptly discontinued when transitioning back to enteral feeding. It is crucial to weigh the benefits and risks of TPN, considering that enteral nutrition is preferred when possible due to fewer complications and better preservation of gut integrity 1. In clinical practice, the decision to initiate TPN should be based on individual patient needs and careful consideration of the potential benefits and risks, with a focus on minimizing complications and optimizing patient outcomes.
From the Research
Total Parenteral Nutrition (TPN) Overview
- TPN is a method of providing essential nutrients to patients who cannot receive them through oral or tube feedings 2
- It involves inserting a catheter into a large central vein to deliver hypertonic dextrose calories, synthetic amino acids or protein hydrolysates, macroelements, electrolytes, and vitamins
Indications for TPN
- Intestinal fistulas, severe short bowel syndrome, unresolving pancreatitis, advanced inflammatory bowel disease, delayed postoperative gastrointestinal function, developmental anomalies of the intestinal tract, protracted diarrhea of infancy, and hypermetabolic states 2
Complications of TPN
- Catheter-related mechanical problems, infections, and metabolic abnormalities 2
- Overfeeding can lead to increased risk of sepsis 3
- Liver injury, risk of infections, and metabolic derangements are also associated with TPN 4
Comparison with Enteral Nutrition (EN)
- EN is now the preferred route of nutrition support, as it promotes gut function and prevents translocation of intestinal bacteria 3
- However, TPN is still a safe and effective alternative when EN is not tolerated or there is gut failure 3
Patient-Specific Feeding
- The decision to initiate TPN should be based on the presence of clinically significant starvation and dysfunction of the gastrointestinal tract 5
- Patient-specific feeding is important, as overfeeding can be harmful, particularly in severely ill patients with preexisting organ failure 5
Note: The study 6 is not relevant to the topic of Total Parenteral Nutrition.