RUFAIDA COLLEGE OF NURSING

JAMIA HAMDARD

ASSIGNMENT ON TPN

SUBMITTED TO SUBMITTED BY

MS. FAREHA KHAN MS. SAFIYA ANSARI

ASSISTANT PROFESSOR MSC. NURSING 1ST YEAR

SUBMITTED ON- 17th FEBRUARY, 2023

 NUTRITION
Nutrition allows the body to be provided with all basic nutrients substrates and energy
required for maintaining or restoring all vital body functions from carbohydrate and fat and
for building up body mass from amino acid.

CLINICAL MANIFESTATIONS
 Malnutrition
 Weight loss
 Reduced basal metabolism
 Depletion skeletal muscle and adipose (fat) stores
 Decrease tissue turgor
 Bradycardia
 Hypothermia

TOTAL PARENTRAL NUTRITION

INDICATION
• When normal oral feeding is not possible e.g.: Chron’s disease, gastric & esophageal
carcinoma, paralytic ileus, generalized peronitis, GI. obstruction, intractable vomiting.
• When food is incompletely absorbed e.g.: Major burns, multiple injuries, radiation therapy,
ulcerative colitis, chemotherapy treatment, short bowel syndrome.
• When food intake is undesirable, in case it is prudent to rest the bowel e.g.: Post GIT
surgery, chronic inflammatory diseases, intractable diarrhea.
• In patients who are able to ingest food, but refuse to do so e.g.: Geriatric post-operative
patients, adolescents with anorexia nervosa, some psychiatric patients with prolonged
depression.
• In patients who, as a consequence of their illness are going to be, or have been NPO for 5 –
7 days.

SHORT-TERM USE
• Bowel injury, surgery, major trauma or burns
• Bowel disease (e.g. obstructions, fistulas)
• Severe malnutrition
• Nutritional preparation prior to surgery.
• Malabsorption - bowel cancer
• Severe pancreatitis
• Malnourished patients who have high risk of aspiration

LONG-TERM USE (HOME PN)

• Prolonged Intestinal Failure
• Crohn’s Disease
• Bowel resection

ADVANTAGES
 Can provide full nutritional support (No limits in concentration of dextrose and amino
acids)
 No risk of thrombophlebitis, No pain.

DISADVANTAGES
 Requires surgery
 More risk of sepsis than peripheral TPN
 High risk of mechanical complications

ROUTES OF TPN
Peripheral TPN
maximum osmolarity; neonates = 1100/L, Pediatrics = 1000/L, Adults = 900/L
ADVANTAGES:
 Does not require surgery
 Less risk of sepsis than central TPN
 No risk of mechanical complications
DISADVANTAGES:
 High risk of thrombophlebitis
 Painful
 Does not provide full nutrition support.
 Needs more fluids to provide more nutrition.
Parenteral Nutrition
• Peripheral Parenteral Nutrition (15 lit D5W/day for a 70 kg !!!)
• Central Parenteral Nutrition

CONTRAINDICATIONS
• Hypersensitivity to corn or corn products
• Hypertonic solutions in patients with intracranial or intra-spinal hemorrhage

MONITORING
• Avoid overfeeding
• Avoid respiratory problem
• Promote nitrogen retention
• Triglyceride clearance
• Fluid and electrolyte
• Weight
• Liver function

COMPLICATION
• Mechanical: occlusion, catheter removal, improper rate, thromboses, pneumothorax.
• Infection: catheter related
• Metabolic: re-feeding syndrome, hyperglycemia, fluid & electrolyte disturbance
• Organic system: hepatobiliary complication, respiratory, cardiovascular, renal

TPN
• Doctors decide patient needs it
• Dietitian sees patient, decides best regime
• Orders bag from pharmacy
• Made up aseptically to requirements
• Start low and build up
• Monitor bloods
ACCESS FOR PN
• Usually central line in ICU – keep a clean port if PN may be needed. 5 lumen
• Short term PN – can have PIC (need a different formula) or PICC
• Long-term TPN – tunnelled subclavian catheter (Hickman) or subcutaneous port is usually
inserted – OBSERVE STRICT ASEPSIS if handling these lines.

OVERFEEDING
• Lactic acidosis
• Hyperglycaemia
• Increased infections
• Liver impairment (Alk phos, ALT, GGT, acalculous cholecystitis)
• Persistent pyrexia

COMPLEX NUTRITION: MONITORING

• Urea, Electrolytes, phosphate, calcium, magnesium
• Glucose
• LFTs
• Fluid balance
• Haematology
• Weight
• Trace elements if long-term

CONCLUSION
• Do not forget about feeding
• Keep an eye on whether nutritional targets are being met
• Speak to the surgeons and dietician
• Do not be reluctant to start PN in a supplemental capacity
• Avoid hyperglycaemia
• Nutrition is often neglected