From the Guidelines
Total Parenteral Nutrition (TPN) is generally recommended over Peripheral Parenteral Nutrition (PPN) for patients requiring long-term nutritional support or those with high caloric needs, due to its ability to provide complete nutritional requirements and higher concentration of nutrients, as seen in the most recent study 1.
Key Differences Between TPN and PPN
- Administration route: TPN is delivered through a central venous catheter, while PPN is administered through peripheral veins.
- Nutrient concentration: TPN allows for highly concentrated solutions (up to 25-30% dextrose, 3-5% protein, and 20% lipids), whereas PPN uses less concentrated solutions (typically limited to 10% dextrose, 3% protein, and 10% lipids).
- Clinical applications: TPN is suitable for patients with high caloric needs or requiring long-term nutritional support, while PPN is generally used for short-term nutritional support (less than 14 days) in patients with mild-to-moderate nutritional deficits.
Considerations for Choosing Between TPN and PPN
- Patient's nutritional requirements: TPN can provide complete nutritional requirements (1800-2500 calories daily), while PPN typically delivers partial nutrition (1000-1500 calories daily) 1.
- Expected duration of therapy: TPN is often used for long-term nutritional support, while PPN is used for short-term support.
- Vascular access: TPN requires a central venous catheter, which carries a higher risk of complications, while PPN can be administered through peripheral veins.
- Overall clinical condition: The choice between TPN and PPN depends on the patient's underlying disease, nutritional risk, and the impact of the surgical procedure, taking into account comorbidities such as cholestasis 1.
Administration of PPN
- Commercially available all-in-one bags can be used to simplify administration 1.
- Nutrient and energy content should reflect each patient's individual needs, considering nutrition obtained orally or enterally 1.
- Incremental administration and continuous or cycling infusion can be used, depending on the patient's needs and mobility 1.
From the Research
Overview of TPN and PPN
- Total Parenteral Nutrition (TPN) and Peripheral Parenteral Nutrition (PPN) are two forms of intravenous nutrition support used in clinical practice.
- TPN is typically administered through a central venous catheter, while PPN is administered through a peripheral vein.
Key Differences
- The main difference between TPN and PPN is the route of administration, with TPN being administered centrally and PPN being administered peripherally 2.
- PPN is considered a safer alternative to TPN, as it avoids the risks associated with central venous catheterization, such as morbidity and mortality 2.
- PPN is also considered a useful therapy for short periods of time, and can be used as an alternative to TPN or as a complement to enteral nutrition and oral nutrition 3.
Indications and Appropriateness
- PPN is indicated for patients who require short-term nutrition support, typically less than 10-14 days 2.
- The appropriateness of PPN use is evaluated based on criteria such as indication, time to initiation, duration of therapy, and percentage of goal daily calories achieved 4.
- Studies have shown that PPN is not always used appropriately, with only one-third of patients receiving appropriate PPN therapy in one study 4.
Complications and Risks
- PPN is associated with risks such as phlebitis and bacteremia, with one study reporting a 43.4% incidence of phlebitis and a 3.1% incidence of bacteremia 4.
- TPN is also associated with risks, including overfeeding, which can lead to complications such as sepsis 5.