Fluids, Electrolytes & Nutrition: Parenteral Nutrition

Parenteral Nutrition

Definitions

  • Total Parenteral Nutrition (TPN) – IV Nutrition Given Through a Central Venous Catheter
  • Peripheral Parenteral Nutrition (PPN) – IV Nutrition Given Through a Peripheral Venous Catheter
    • Lower Osmolarity (Still Hyperosmolar)

Indications

  • Anticipated NPO Status with Enteral Nutrition Contraindications for:
    • Adequately Nourished: 7-10 Days
    • Previously Malnourished: 5-7 Days
  • Consider Giving Preoperatively for Severe Malnutrition (> 15% Weight Loss)

Contraindications

  • Hyperosmolarity
  • Severe Hyperglycemia
  • Severe Electrolyte Abnormalities
  • Volume Overload
  • Inadequate IV Access – Hyperosmolarity is Damaging to Peripheral Veins
  • Inadequate Attempts to Feed Enterally

TPN Contents

  • Nutritional Basis: Dextrose/Glucose
  • Other Contents:
    • Amino Acids (Includes Most Amino Acids – Except Arginine & Glutamine)
    • Electrolytes
    • Vitamins & Minerals
  • Lipids Not Included (Lipid Emulsion Given Separately)

Complications

  • Central Line Issues:
    • Pneumothorax
    • DVT
    • Bloodstream Infection
  • Liver Dysfunction: Stasis, Sludge, Stones, Fibrosis & Cirrhosis
  • Metabolic Bone Disease
  • Metabolic Deficiencies
    • Micronutrient Deficiencies
    • Refeeding Syndrome
    • Hyperglycemia
  • Hypoglycemia with Abrupt Cessation
    • Cessation Should Be Tapered if Diabetic (Tapering is Unnecessary if Otherwise)
  • Bacterial Translocation
    • From Lack of Enteral Feeding Causing Mucosal Barrier Alteration