Total Parenteral Nutrition
Total Parenteral Nutrition (TPN) is a last resort feeding mechanism for those with total gut failure who cannot inject food orally or tolerate tube feedings. It can also be used temporarily in cases where a nutrition boost is needed short-term or immediately following surgery.
In order to receive TPN, a central line must be inserted. Typically, the first line is called a PICC line and is inserted into a vein in the arm. PICC lines are different from peripheral lines in that they are longer and the tip ends up in a large vain close to the heart. They are longer lasting than a regular IV line. If a PICC line is not an option, there are other central line catheters than can be used including hickman's, ports, hone's groshongs, among others. These are typically placed into veins in the chest area. If those areas become inaccessible, the lines can also be placed in the neck. In some instances, on an emergency, in-patient basis, lines can be placed in the groin area. This is not recommended long-term or on an outpatient basis due to an increased risk of infection.
TPN is an excellent way for a person to gain weight and increase nutritional status in a short amount of time. TPN is closely monitored and managed by a nurse or dietitician in order to ensure the patient's individual nutritional needs are being met. People on TPN usually require home health care nursing in order to get labs once or twice a week, have health and nutrition closely monitored, blood sugar checked, and for dressing changes.
Unfortunately, with the benefits of TPN also come complications. People on TPN are at high risk of sepsis (infection in the blood stream). It is more common to develop sepsis on TPN than people who are on chemo because the high sugar content in TPN draws bacteria into the central line. In addition, people on TPN often have a lot of bacteria and fungus which builds up in the small bowel and passes into the bloodstream increasing infection rates. Another complication of TPN includes liver failure if used long term. This varies in individuals as some on it for many years never develop problems, while other develop them within a few years.
TPN is usually run over a 12-24 hour period. It is usually provided along with a portable backpack so the patient is able to get out during the day or not be tied to a pole throughout the infusion.
Sterility is crucial when dealing with central lines. Alcohol must be used on everything. Hands must be washed in advance, and touching any part of the skin around the area should be avoided. Most home health care providers use an entirely needless system which cuts down on infection risk and is safer for the patient.
TPN must be refrigerated at all times and should be set out 1-2 hours before starting infusion. If traveling, it is necessary to drive with a cooler or have the TPN shipped to the destination. Often, additional additives are provided such as vitamins or insulin. TPN may be clear or white and often rotated. Clear TPN does not include lipids, while white TPN does. If possible, lipids should be limited to as few days as possible to decrease the possibility of liver damage.