Pharmacy Product Info

Thursday, December 28, 2006

Total parenteral nutrition

Total parenteral nutrition (TPN), is the follow of feeding a person intravenously, circumventing the gut. It is usually used following surgery, when feeding by mouth or using the gut is not possible, when a person's digestive system cannot attract nutrients due to chronic disease, or, alternatively, if a person's nutrient condition cannot be met by enteral feeding (tube feeding) and supplementation. It has been used for comatose patients, although enteral feeding is typically preferable, and less prone to complications. Short-term TPN may be used if a person's digestive system has shut down, and they are at a low sufficient weight to cause concerns about nutrition during a complete hospital stay. Long-term TPN is infrequently used to treat people suffering the extended consequences of an accident or surgery. Most controversially, TPN has unlimited the life of a small number of children born with absent or severely birth-deformed guts. The oldest were eight years aged in 2003.

The favored method of delivering TPN is with a medical infusion pump. A germ-free bag of nutrient solution, between 500 mL and 4 L is provided. The pump infuses a little amount (0.1 to 10 mL/hr) continuously in order to stay the vein open. Feeding schedules vary, but one ordinary regimen ramps up the nutrition over a little hours, levels off the rate for a few hours, and then ramps it down over a few additional hours, in order to simulate a ordinary set of meal times.

The nutrient solution consists of water, glucose, salts, amino acids, vitamins and occasionally emulsified fats. Long term TPN patients sometimes endure from lack of trace nutrients or electrolyte imbalances. Because increased blood sugar usually occurs with TPN, insulin may also be added to the infusion. Infrequently, other drugs are added as well. Chronic TPN is performed through a Hickman line or a Port-a-Cath. In infants, occasionally the umbilical vein is used.

Battery-powered ambulatory mixture pumps are used with chronic TPN patients, and typically the pump and a small (100 ml) bag of nutrient to keep the vein open are accepted in a fanny pack. Outpatient TPN practices are still being sophisticated. Aside from their confidence on a pump, chronic TPN patients live quite normal lives.

The most general complication of TPN use is bacterial infection, typically due to the increased infection risk from having an indwelling middle venous catheter. Liver stoppage may sometimes occur; a recent study at Children's Hospital Boston on the reason suggests it is due to a large difference in omega-6 to omega-3 ratio. When treated with a dissimilar fatty acid infusion (which is not approved for use in the U.S.) numerous patients were able to recover from their condition.


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