From the Guidelines
Total Parenteral Nutrition (TPN) is indicated for patients who are malnourished or at risk of becoming malnourished and have an inadequate or unsafe oral intake, a non-functioning or perforated gut, or in whom the gut is inaccessible. The indications for TPN include severe gastrointestinal dysfunction, such as bowel obstruction, ileus, severe malabsorption, short bowel syndrome, or high-output fistulas 1. TPN is also appropriate for patients with severe acute pancreatitis, prolonged NPO status before major surgery, severe hyperemesis gravidarum, and certain oncology patients undergoing intensive treatments 1.
Key Indications for TPN
- Severe gastrointestinal dysfunction
- Inadequate or unsafe oral intake
- Non-functioning or perforated gut
- Gut inaccessibility
- Severe acute pancreatitis
- Prolonged NPO status before major surgery
- Severe hyperemesis gravidarum
- Certain oncology patients undergoing intensive treatments
According to the most recent and highest quality study, patients who will benefit from TPN are those who cannot meet their nutritional needs through enteral feeding for an extended period, typically more than 5-7 days 1. The decision to start TPN requires careful consideration of risks versus benefits, as it carries complications including line infections, metabolic disturbances, and liver dysfunction. Whenever possible, enteral nutrition should be preferred as it maintains gut integrity and immune function while carrying fewer complications.
Considerations for TPN
- Risks versus benefits
- Complications, including line infections, metabolic disturbances, and liver dysfunction
- Preference for enteral nutrition when possible
In patients with chronic intestinal failure, TPN may be the primary life-saving therapy, and home parenteral nutrition (HPN) may be necessary 1. The indication for HPN in patients with chronic intestinal failure typically includes short bowel syndrome, fistula, bowel dysmotility, and radiation enteropathy.
Special Considerations
- Chronic intestinal failure
- Home parenteral nutrition (HPN)
- Short bowel syndrome
- Fistula
- Bowel dysmotility
- Radiation enteropathy
Postoperative TPN is beneficial in undernourished patients in whom enteral nutrition is not feasible or not tolerated, and in patients with postoperative complications impairing gastrointestinal function who are unable to receive and absorb adequate amounts of oral/enteral feeding for at least 7 days 1.
Postoperative TPN
- Undernourished patients
- Enteral nutrition not feasible or not tolerated
- Postoperative complications impairing gastrointestinal function
- Inability to receive and absorb adequate amounts of oral/enteral feeding for at least 7 days
From the Research
Indications for Total Parenteral Nutrition (TPN)
The indications for TPN can be summarized as follows:
- Severe nutritional problems in patients with inflammatory bowel disease (IBD) who are unable to tolerate enteral nutrition 2
- Malnourished patients with intestinal failure due to Crohn's disease (CD) 2
- Patients with fistulizing CD who require efforts to close enterocutaneous or other complicated fistulas 2
- Patients with short bowel syndrome following extensive resections for CD 2
- Patients who are unable to receive enteral nutrition for other reasons 2
- Preoperative nutrition for patients with IBD who are undergoing surgical treatment 3
- Patients with gastrointestinal cancers who require nutrition as a bridge therapy to further cancer treatment 4
- Postoperative nutrition for patients undergoing major colorectal surgery 5
- Patients with moderate to severe CD who are undergoing bowel resection and primary anastomosis 6
Patient-Specific Factors
When considering TPN, the following patient-specific factors should be taken into account:
- Functional status 4
- Nutritional status 4
- Degree of symptom control 4
- Ability to safely administer nutrition 4
- Disease activity and severity 2, 3, 6
- Presence of complications such as fistulas or short bowel syndrome 2
Clinical Situations
TPN may be indicated in the following clinical situations: