TPN (Total Parenteral Nutrition) *Special Edition*

What is a TPN? TPN is a intravenous fluid for patients in need of nutrition requirements
who are unable to eat or cannot get enough nutrition from foods they eat. TPN's contains IV solutions such as dextrose, normal saline, etc also lactated ringers such as potassium, calcium (electrolytes),etc. TPN's are prepared in a laminar flow hood using the aseptic technique. TPN's are given in large amounts that have varieties of ingredients/solutions, so in this case healthcare professionals need to be accurate when preparing a TPN so the patient won't get harmed. TPN's are given at the hospital, long-term care centers, or at home.

Who specifically needs a TPN?

  • Patients with infections or problems in their pancreas, intestines (bowel), or other body organs
  • Food tubes going into their stomach that cannot give them enough nutrition
  • AIDS (acquired immunodeficiency syndrome)
  • Some types of cancer
  • Starvation or anorexia
  • Serious burns

How is a TPN given? A healthcare professional will place a special IV line in the patients arm, upper chest, or neck. Their TPN will be connected to a pump that controls how fast the TPN goes into their vein.

What is the difference between a TPN and a PPN (peripheral parenteral nutrition) ? First of all a TPN and a PPN are used for the same cause which is to give the nutrition requirements that a patient needs. The difference is that a TPN must be given through a central venous catheter and the PPN may be given through a regular IV. Also TPN's are preferred nutritional supplement for a long time because it delivers through a central vein as for PPN's are only preferred partially because it is not safe to use hyperosmolar solutions in peripheral veins for a very long time. Also TPN comes in a higher concentration & it can only be administer through a large vein such as the chest or neck as for PPN comes in a lesser concentration that can be delivered through a peripheral vein.

EXTRA: <Here are some common addictives that are in a TPN bag>

Sodium: Helps control water distribution and maintain a normal fluid balance
Potassium: Needed for cellular activity and tissue synthesis
Magnesium: Helps absorb carbohydrates and protein

Calcium: Needed for bone and teeth development also aids in clotting
Phosphate: Minimizes the threat of peripheral parenthesis
Chloride: Regulates the aid base equilibrium and maintains osmotic pressure
Acetate: Added to prevent metabolic parenthesis
Ascorbic acid: Helps in wound healing
Vitamin A: Maintaining integrity of skin and essential to vision
Vitamin D: Essential for bones and maintenance of serum calcium levels
Vitamin B complex: Helps in final absorption of carbohydrates and protein
Folic acid: DNA formation and promotes growth and development
Vitamin K: Helps prevent bleeding disorders
Trace elements: Help in wound healing and red blood cells synthesis
Interferon: May be added as a iron supplement
Insulin: Metabolize high glucose load

EX) You are preparing a TPN with 500ml of 7.5% Travasol and 500ml of 50% dextrose injection. What is the final % concentration of the Travasol and the dextrose in the TPN?

500ml X 0.075 (7.5% / 100) = 37.5% Travasol
500ml X 0.5 (50% / 100) = 250 / 100 = 2.5------<25% dextrose