Patient Care - TPN (Total Parenteral Nutrition) TOTAL PARENTERAL NUTRITION (INTRAVENOUS HYPERALIMENTATION) Total parenteral nutrition (TPN, intravenous hyperalimentation) is the continuous intravenous infusion of a hyperosmolal solution that consists of protein hydroly­sates or crystalline amino acids in 20 to 25 per cent dex­trose. It provides approximately 5.25 to 6.0 gm. of nitrogen (equivalent to 32.5 to 37.5 gm. of protein) and approxi­mately 900 kcal. per liter. Electrolytes are added to the infusion bottles as indicated. Vitamins and trace elements are either added to the infusion or given parenterally as indicated. The TIN solution is irritating to peripheral veins. Therefore, it is usually given into a large bore vein such as the subclavian vein or an adjacent vein, through a central venous catheter. The ability to tolerate partial or complete starvation and to respond to the additional energy needs of trauma, major surgery, or sepsis depends on a patient's nutritional and metabolic state. Daily short-term calorie requirements have been described on page 478. When a patient is unable to eat for eight or more days, nasogastric tube feedings can be used as described in the preceding chapter. An alternative is total parenteral nutrition. Tube feedings or total paren­teral nutrition can be continued for months. INDICATIONS      Total parenteral nutrition is indicated only when oral or tube feeding (nasogastric, gastrostomy, or jejunostomy) is contraindicated or inadequate, and when conventional in­travenous fluids have been used for eight or more days and are no longer adequate for the needs of the patient. It has therefore been used in the following situations: 111. Ingestion of food is impossible or unwise, as in obstruc­tive lesions of the 222. gastrointestinal tract, peritonitis or paralytic ileus. Enterocutaneous fistulas which have not healed with con­ ventional medical treatment. 333. Inflammatory diseases of the bowel, such as ulcerative colitis or regional enteritis, which have not healed with medical treatment. 444. Severe uncontrollable malabsorptive states with malnu­ trition. 555. Hypermetabolic states associated with extensive bums, major trauma, severe infections. 666. Prolonged coma where nasogastric tube feeding has led to complications such as aspiration, and where there is a possibility of recovery. CONTRAINDICA TIONS Acidosis, severe hepatic disease, acute renal failure or azotemia are all contraindications to the use of TPN. In addition, TPN must be used cautiously with congestive heart failure because fluid overload must be avoided.		Patient Care Patient Care - Medical Record Patient Care - Hospital Diets Total Parenteral Nutrition Third Space Fluid Peritoneal Dialysis Patient Care - Diarrhea Patient Care - Fever Patient Care - Pain Relief Patient Care - Narcotics Patient Care - Hypnotic drugs
	Hospital Diets TPN - Nutritional Requirements