Total Parenteral Nutrition (TPN)

Total Parenteral Nutrition (TPN) is a topic covered in the Pocket ICU Management.

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First Things First (assess & treat for the following)

  • Is TPN appropriate?
    • Indications:
      • Enteral nutrition always preferred
      • Nonfunctioning GI tract (malabsorption, massive small bowel resection, intractable nausea/vomiting/diarrhea, intestinal obstruction)
      • Moderate/severe stress
      • Severely malnourished
    • Contraindications
      • Functioning GI tract
      • Functioning GI tract anticipated in 5-7 days
      • Inability to gain venous access
      • Risks outweigh benefits (see Complications section)
      • Terminal illness/comfort measures only
  • Which is better, central or peripheral parenteral nutrition?
    • Central parenteral nutrition: line tip in SVC
      • May be placed percutaneously via subclavian (preferred), internal jugular or femoral veins . A peripheral vein may be used to insert a long catheter (PICC, “long arm Groshong”).
      • May be placed surgically (Hickman, Port-a-cath, Groshong)
    • Peripheral parenteral nutrition: administered through a peripheral vein
      • Infused solution must be dilute (< 900 mOsm).
      • Difficult to meet nutritional needs if fluid restriction required
      • Short-term use only (< 10-14 days) because of increased risk of thrombophlebitis
      • Not intended for severely malnourished pts

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Last updated: May 5, 2010