What is Total Parenteral Nutrition?
TPN is the administration of nutrition through an IV method, ensuring nutrition enters the body through the veins rather than the traditional feeding method. Patients with TPN can receive a variety of nutrients, typically including protein, fat, minerals, carbohydrate, electrolytes, and vitamins. TPN typically combines the essential nutrients a patient needs within a solution of water. TPN solutions are customized to individual requirements, based on health data, patient's age, organ's functions, etc.
Total Parenteral Nutrition must be administered in a fully sterile and clean environment using a central venous catheter, which is a needle or a catheter placed into one of the large veins going to the heart. The central venous catheter remains in place. Patients on TPN receive IV feeding 5 to 7 days a week, for 10 to 12 hours each time, either during daytime or nighttime.
Who needs TPN feeding?
Parenteral Nutrition is designed to bypass the digestive system. Doctors recommend it for patients who don't have a functional gastrointestinal tract, either because the absorbing ability is compromised or because the tract is interrupted. It can also be used when complete bowel rest is required. Diseases, such as the following, require TPN:
- Short bowel syndrome
- Gastrointestinal bleeding
- Small bowel obstruction
- Extremely severe Crohn's disease
- Congenital gastrointestinal anomalies
- Cardiac and renal impairment
- Acute pancreatitis
- Etc.
Some patients may require TPN for different periods of time, ranging from temporary IV nutrition feeding to lifetime PN requirements. More often than not, patients who require long-term TPN can work with their doctors to arrange home-based therapy for convenience. According to the American Society for Parenteral and Enteral Nutrition, approximately 25,000 patients receive parenteral nutrition at home.
How do doctors and patients manage TPN therapy?
The purpose of TPN is to deliver essential nutrients to the body. Consequently, the TPN ingredients are carefully selected to meet each patient's individual nutrition needs.
As mentioned earlier, the medical history of the patient plays a significant role in the choice of ingredients. Indeed, a patient with kidney disorder is likely to receive less liquid in the TPN to prevent buildup in the bloodstream. On the other hand, some medical conditions, such as respiratory failure, will require a higher volume of liquid intake. Additionally, energy, vitamin, and mineral requirements also vary by age group.
Administration in a medical environment
The patient's progress is monitored closely by a medical and nutrition team. For TPN administered in a hospital or care center environment, the specialist team is present within the healthcare establishment and responsible for:
- Safe storage of TPN doses
- Preparation of each dose
- Customizing dose ingredients based on lab results
- Monitoring of nutrition and other health levels related to the patient's condition
- Sanitizing and sterilizing the central venous catheter, feeding tubes, and the surrounding areas
TPN management at home
For home TPN administration, it's essential for the patient and medical team to work hand-in-hand. Doctors work in conjunction with a home infusion company and lab results to ensure TPN doses are adapted to the nutrition requirements of each patient.
A patient receiving TPN at home is under constant monitoring of an interdisciplinary nutrition and medical team that takes frequent measurements of:
- Patient's weight and BMI
- Electrolytes levels
- Complete blood count: white blood cells, red blood cells, blood platelets
- Liver function tests
- Nutritional assessments
- Other medical tests relevant to the patient's health condition(s)
Patients also receive the support of a qualified home nurse to be trained in the correct administration method and prevent risks of infection. The patient becomes responsible for some steps of the TPN process:
- Safe storage
- Safe and sterile administration
- Management of other food intakes throughout the day — which must typically be avoided
- Keeping up-to-date with essential tests
Without appropriate follow-up and monitoring, patients with TPN could develop serious health complications, such as liver dysfunction, glucose anomalies, and catheter-induced sepsis. Some complications can be reversed or prevented through health monitoring and medical management with an expert team.
Total Parenteral Nutrition can significantly transform the quality of life for patients with long-term conditions that affect the safe absorption of nutrients through the gastrointestinal tract. Home TPN can protect patients' independence and flexibility but requires diligent monitoring, appropriate administration care, and dedicated customized doses.
Please contact the Kidney360 team if you wish to have more information regarding TPN management.
