TOTAL PARENTERAL NUTRITION:

NURSING CONSIDERATIONS

OBJECTIVES
DEFINE WHAT IS TOTAL PARENTERAL
NUTRITION.
REVIEW ITS ADVANTAGES AND
DISADVANTAGES.
ENUMERATE THE NURSING
CONSIDERATIONS IN THIS KIND OF
NOURISHMENT OF PATIENT

COURSE OUTLINE
I. Definition of terms
II.Advantages and Disadvantages
of TPN
III.Nursing Considerations

GRAINS

VEGETABLES

FRUITS

OILS

MILK

MEAT & BEANS

Parenteral Nutrition:
- Infusion of nutrients thru the bloodstream
- To prevent or correct specific nutrient
deficiencies and to prevent the adverse
effects of malnutrition when the GIT cannot
be used effectively or safely.
- Recommended if enteral intake has been, or
is anticipated to be, inadequate for 7 to 10
days

TPN VS PPN
TOTAL PARENTERAL NUTRITION
FORMERLY CALLED
HYPERALIMENTATION
NO OTHER SOURCE OF NUTRITION
PARTIAL PARENTERAL NUTRITION
WHEN OTHER ROUTES ARE USED IN
COMBINATION WITH THE PARENTERAL
ROUTE

CENTRAL VS PERIPHERAL
CENTRAL PARENTERAL NUTRITION
ADMINISTERED INTO A CATHETER THAT
EMPTIES INTO A CENTRAL VEIN
(CRANIAL OR CAUDAL VENA CAVA)

PERIPHERAL PARENTERAL NUTRITION

ADMINISTRED INTO A PERIPHERAL VEIN
(ANY VEIN APART FROM THE VENA CAVA
)

INDICATION S FOR
PARENTERAL NUTRITION
INABILITY TO FEED ENTERALLY OR TO MAINTAIN
NUTRITIONAL GOALS ENTERALLY
NEWBORNS WITH GI ABNORMALITIES, SHORT
BOWEL SYNDROME, MALABSORPTION SYNDROMES,
FUNCTIONAL GI DISORDERS
CERTAIN SURGICAL CONDITIONS
POST OPERATIVE ILEUS OVER 7-10 DAYS

HYPERCATABOLIC STATES
CRITICAL ILLNESS, MALIGNANCY, CACHEXIA

INDICATIONS FOR
PN
CANT EAT
WONT EAT
SHOULDNT EAT
CANT EAT ENOUGH

PARENTERAL NUTRITION
ACCESS
Central

Peripheral

Long term PN (>14 days)

Short term PN (< 14 days)

Can tolerate PN with high

osmolarity (>900mosm)

Only for PN with PN low

osmolarity (<900mosm)

Can be maintained for 2-4 weeks

Needs to be rotated(transferred to
another site) every 48-72 hours

Higher risk for catheter related

infections

Lowest risk for catheter-related

infections

Less risk for thrombophlebitis

High risk for thrombophlebitis

Two types of Parenteral Nutrition:

1. Central parenteral nutrition
2. Peripheral vein nutrition

Central PN (TPN) is a concentrated formula

which is hyperosmolar and must be delivered
into a central vein. TPN provides:
Carbohydrates in the form of glucose.
Protein in the form of amino acids.
Lipids in the form of triglycerides.
Electrolytes.
Vitamins and trace minerals.

Conditions warranting cautious use of

PN:
Azotemia
Congestive heart failure
Diabetes Mellitus
Electrolyte disorders
Pulmonary disease

Parenteral nutrition
(PN)
Peripheral Parenteral Nutrition
(PPN)
Total Parenteral Nutrition (TPN)

"If the gut works, use it"

Potential benefits of enteral nutrition over PN include:
Physiologic
Nutrients are metabolized and utilized more effectively
via the enteral than the parenteral route.
The gut and liver process enteral nutrients before their
release into systemic circulation.
The gut and liver help maintain the homeostasis of the
amino acid pool as well as the skeletal muscle tissue.

Immunologic
Gut integrity is maintained by enteral nutrients through
the prevention of bacterial translocation from the gut,
systemic sepsis, and potential increased risk of
multiple organ failure.
Lack of GI stimulation may promote bacterial
translocation from the gut without concurrent enteral
nutrition.
Provision of early enteral nutrition may minimize risk of
gut related sepsis.

Safety (avoid complications

related to intravenous access):
Catheter sepsis
Pneumothorax
Catheter embolism
Arterial laceration

Cost
Cost of EN formula is less than PN.
Cost of equipment and personnel for
preparation and administration is
less.

Issues

Algorithm for Nutritional

Support
Nutritional Assessment

Functioning
GIT?

Yes

Enteral
Nutrition

No

Long term
- Gastrostomy
- Jejunostomy
Short term
- Nasogastric
- Nasoduodenal
- Nasojejunal

Parenteral Nutrition

Short Term?

Yes

Peripheral
PN
GI Function
Returns to
Normal?

No

Long-term or
Fluid Restriction

Yes

Central PN

Yes

Standard
Nutrients

Thank you for your kind attention!!!!