PARENTERAL NUTRITION

Definition
Sir Christopher Wren in 1658 is feeding a person intravenously, bypassing the usual process of eating and digestion The person receives nutritional formulas that contain nutrients such as salts, glucose, amino acids, lipids and added vitamins

Types of parenteral nutrition

Partial parenteral nutrition (PPN) is indicated for clients who can meet some of their nutritional requirements orally (i.e. shortened small bowel due to injury/disease) Total parenteral nutrition (TPN) is required for severely malnourished clients, clients with severe and extensive burns or other trauma, and for GI recovery

Indication
a patient is severely undernourished, and needs to have surgery, radiotherapy or chemotherapy; a patient suffers from chronic diarrhea and vomiting; a baby's gut is too immature; a patient's (their "gastrointestinal tract") is paralysed, for example after major surgery. Bowel obstruction Patients with inability to absorb nutrients via GI tract

When NOT to use

Patients who have a functional and usable GI tract, capable of absorption of adequate nutrients When sole dependence on TPN is anticipated to be less than 5 days Inability to obtain venous access A prognosis that does not warrant aggressive nutritional support

Routes
Umbilical vein (upto day 7) Peripheral vein Central vein

Composition in pre-digested form

Protein as amino acids Fat as lipid emulsion Carbohydrates as dextrose Multivitamins electrolytes Trace elements

Vitamin Vitamin A Vitamin D Vitamin E Ascorbic acid Folacin Niacin Riboflavin Thiamin B6 (pyridoxine) B12 (cyanocobalamin) Pantothenic acid Biotin Mineral Zinc Copper Chromium Magnesium

Amount 3,300 IU 200 IU 10 IU 100 mg 400 m g 40 mg 3.6 mg 3 mg 4 mg 5mg 15 mg 60 m g Amount 2.5 4.0 mg* 0.5 1.5 mg 10.0 15.0 m g 0.15 0.8 mg

Electrolytes Potassium Sodium Phosphorus Magnesium Calcium Chloride

Medications That May Be Added

Phytomenadione Selenium Zinc chloride Levocarnitine Insulin

Metoclopromide Ranitidine Sodium iodide Heparin Octreotide

Complications
METABOLIC CATHETER/PUMP COMPLICATIONS Infection Hyperglycemia Hypoglycemia Dehydration Liver failure Priapism Air embolism Blood in catheter Catheter tear Catheter clot Phlebitis accidental arterial puncture