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TOTAL PARENTERAL NUTRITION - Coggle Diagram
TOTAL PARENTERAL NUTRITION
DEFINITION
TPN IS PREPARATION OF STERILE SOLUTION THAT CONTAINING AN OPTIMUM PROFILE OF NUTRITION GIVE TO PATIENT VIA PARENTERAL ROUTE
TO WHOM WE GIVE TPN
Patient who can’t eat
Patient who won’t eat
Patient who shouldn’t eat
Patient who can’t eat enough
Purposes/Indications
TPN is given to patients whose gastrointestinal tract
(GIT) is not functional (Abnormal gut function)
Anticipation of under nutrition (defined as < 50% of metabolic needs met) for > 7 days (patient unable to eat orally)
To help malnourished patients undergoing highdose chemotherapy or radiation therapy (patients
who cannot ingest large volumes of oral feedings)
After major surgery, severe burns, and head
trauma, especially in patients with sepsis
FORMULATION OF TPN
The proportions and mix of components of solutions used for intravenous nutrition can vary considerably depending upon the patient’s nutritional status and underlying clinical condition
COMPOSITION OF TPN :
Proteins -Amino acid solutions
Carbohydrates-Dextrose solutions
Lipid-Fat emulsions
Electrolytes-Sodium chloride soln., potassium
chloride soln.
Vitamin- vitamin B
ROUTE OF PN
Though CENTRAL LINE
Through PICC LINE (PERIPHERALLY
INSERTED CENTRAL CATHETER)
Hypertonic solution :
is one where the concentration of solutes is greater outside the cell than inside it
A Hypotonic solution
is one in which the concentration of solutes is greater inside the cell than outside of it
Advantages TPN
PN allows Total nutrition to be given even when the digestive tract isn't working
It can allow the digestive tract to rest so that it can heal - for example, after surgery to the stomach or bowel.
How to begin TPN administration???
Firstly - Patient assessment using the ESPEN guidelines (The Europian Society for Parenteral and Enteral Nutrition
Health care Professional will decide “What type of TPN formula” and the flow rate for patient
They will make a TPN indent form and give to
Pharmacy department
Pharmacist will prepare the TPN solution based
on what is indent
Strict sterile techniques must be used during
insertion and maintenance.
External tubing should be changed q 24 h with the first bag of the day and Dressings are usually changed q 48h using strict sterile techniques.
Pharmacist Responsibilities
Nutritional assessment of the patient,
together with the dietician.
Design TPN formula to meet patient’s
nutritional needs.
Daily writing of TPN orders to include lab evaluation, fluid needs, caloric and protein needs.
Daily calculation of calories and protein (to include all sources of glucose from IVPB, IV fluids, etc.)
Correction of Electrolyte imbalance
Monitor drug-nutrient and lab-nutrient interactions.
Prepare for 24-hour on cal
Monitoring of TPN
Fluid intake and output should be monitored
continuously.
Liver function tests should be done.
When the patient becomes stable, blood tests can be
done much less often.
Physical examination; see Obesity and the Metabolic syndrome: Body composition analysis) should be repeated at 2-wk intervals.
Disadvantages TPN
Requires placement of a central venous catherer
non use of guts lead intestinal muscosal atrophy probably increase bacteria infection
Risks of TPN
Infection
Blood clots.
TPN liver disease or damage
Growth and developmental delays in
Pediatrics
Abnormalities in glucose, serum
electrolytes and minerals
Adverse reactions to lipid emulsions
. Metabolic bone disease
Limitations
Patients who have renal insufficiency and are
not receiving dialysis .
Patients who have liver failure need less protein and high percentage of essential amino acids
For patients with heart or kidney failure,
volume (liquid) intake must be limited
For patients with respiratory failure