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Encyclopedia > Total parenteral nutrition

Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, circumventing the gut. For the Physics term GUT, please refer to Grand unification theory The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and...

Contents

General Usage

TPN is normally used following surgery, when feeding by mouth or using the gut is not possible, when a person's digestive system cannot absorb nutrients due to chronic disease, or, alternatively, if a person's nutrient requirement cannot be met by enteral feeding (tube feeding) and supplementation. It has been used for comatose patients, although enteral feeding is usually preferable, and less prone to complications. Short-term TPN may be used if a person's digestive system has shut down (for instance by Peritonitis), and they are at a low enough weight to cause concerns about nutrition during an extended hospital stay. Long-term TPN is occasionally used to treat people suffering the extended consequences of an accident or surgery. Most controversially, TPN has extended the life of a small number of children born with nonexistent or severely birth-deformed guts. The oldest were eight years old in 2003. In medicine, a chronic disease is a disease which has developed slowly or gradually. ... A feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by swallowing. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ... 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ...


The preferred method of delivering TPN is with a medical infusion pump. A sterile bag of nutrient solution, between 500 mL and 4 L is provided. The pump infuses a small amount (0.1 to 10 mL/hr) continuously in order to keep the vein open. Feeding schedules vary, but one common regimen ramps up the nutrition over a few hours, levels off the rate for a few hours, and then ramps it down over a few more hours, in order to simulate a normal set of meal times. An infusion pump or perfusor infuses fluids, medication or nutrients into a patients circulatory system. ... Sterilization (or sterilisation) is the elimination of all transmissible agents (such as bacteria, prions and viruses) from a surface, a piece of equipment, food or biological culture medium. ...


The nutrient solution consists of water, glucose, salts, amino acids, vitamins and (more controversially) sometimes emulsified fats. Long term TPN patients sometimes suffer from lack of trace nutrients or electrolyte imbalances. Because increased blood sugar commonly occurs with TPN, insulin may also be added to the infusion. Occasionally, other drugs are added as well. Impact of a drop of water Water is a chemical substance that is essential to all known forms of life. ... Glucose (Glc), a monosaccharide (or simple sugar), is the most important carbohydrate in biology. ... A magnified crystal of a salt (halite/sodium chloride) Salt covering the floor of Bad Water in Death Valley, CA, the lowest point in the US. A salt, in chemistry, is any ionic compound composed of cations (positively charged ions) and anions (negative ions) so that the product is neutral... Phenylalanine is one of the standard amino acids. ... Retinol (Vitamin A) For the record label, see Vitamin Records Vitamins are nutrients required in very small amounts for essential metabolic reactions in the body. ... Fats consist of a wide group of compounds that are generally soluble in organic solvents and largely insoluble in water. ... An electrolyte is a substance containing free ions which behaves as an electrically conductive medium. ... In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... Insulin (from Latin insula, island, as it is produced in the Islets of Langerhans in the pancreas) is a polypeptide hormone that regulates carbohydrate metabolism. ...


Chronic TPN is performed through a Hickman line or a Port-a-Cath (venous access systems). In infants, sometimes the umbilical artery is used. A Hickman line in a leukemia patient. ... A Port-a-Cath® is a device for intravenous access in patients who require frequent or continuous administration of intravenous substances. ... Umbilical arteries carry deoxygenated blood from the fetus to the placenta in the umbilical cord. ...


Battery-powered ambulatory infusion pumps are used with chronic TPN patients, and usually the pump and a small (100 ml) bag of nutrient to keep the vein open are carried in a fanny pack. Outpatient TPN practices are still being refined.


Aside from their dependence on a pump, chronic TPN patients live quite normal lives.


Complications

The most common complication of TPN use is bacterial infection, usually due to the increased infection risk from having an indwelling central venous catheter. Liver failure may sometimes occur; a recent study at Children's Hospital Boston on the cause suggests it is due to a large difference in omega-6 to omega-3 ratio. When treated with a different fatty acid infusion (which is not approved for use in the U.S.) two patients were able to recover from their condition.[1] In medicine, a central venous catheter (CVC or central (venous) line) is a catheter placed into a large vein in the chest or groin. ... The liver is an organ present in vertebrates and some other animals. ... Liver failure is the final stage of liver disease. ...


For more information, please refer to this paper in the journal Pediatrics. Kathleen M. Gura, Christopher P. Duggan, Sharon B. Collier, Russell W. Jennings, Judah Folkman, Bruce R. Bistrian and Mark Puder. "Management Short Bowel Syndrome Using Parenteral Fish Oil: Implications for Future Reversal of Parenteral Nutrition–Associated Liver Disease in Two Infants With Short Bowel Syndrome" Pediatrics 2006;118;197-201


See also

An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ...

References

  1. ^ PEDIATRICS Vol. 118 No. 1 July 2006 p e197-e201

External links

  • TPN/PPN Calculator by Ryan Heinrick
  • "Why does prolonged TPN cause liver damage in infants?", Children's Hospital Boston
  • TPN Blogs on Nutrishare (a Home TPN provider)
  • TPN Drug Information from MedlinePlus NIH Database
  • TPN Care from the World Health Library

  Results from FactBites:
 
Total parenteral nutrition - Wikipedia, the free encyclopedia (417 words)
Total parenteral nutrition (TPN), is the practice of feeding a person without using the gut, i.e.
Battery-powered ambulatory infusion pumps are used with chronic TPN patients, and usually the pump and a small (100 ml) bag of nutrient to keep the vein open are carried in a fanny pack.
The most common complication of TPN use is bacterial infection, usually due to the increased infection risk from having an indwelling central venous catheter.
  More results at FactBites »

 
 

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