For what complication should a nurse monitor in a patient on total parenteral nutrition TPN?

Total parenteral nutrition can provide an individual with the necessary nutritional support and provision of therapeutic nutrients to maintain or restore optimal nutrition status and health. Total Parenteral Nutrition bypasses the digestive system by dripping a nutritionally adequate hypertonic solution containing glucose, protein, hydrolysates, minerals and vitramins directly into the venous system through an indwelling catheter into the superior vena cava or another main vein.

MACRO-NUTRIENTS:

• Carbohydrates [glucose]
• Proteins [amino acids]
• Lipids [fatty acids]

OTHERS:

• Electrolytes

MICRO-NUTRIENTS:

• Multi-Vitamins [eg. Vitamin B]
• Trace Elements/Minerals [eg. Selenium & Manganese]

A bag of TPN provides the patient with about 2270kcal nutritional intake. This high calorie intake is not considered to be too much since patients on TPN are usually fighting inflammation, requiring wound healing etc.

Indications for Total Parenteral Nutrition

Total Parenteral Nutrition is indicated for patients who:

• are lacking nutritional requirements [commonly related to health-related conditions]
• have documented inadequate oral intake [common indication in the elderly]
• experience an unpredictable return of their GI function [eg. malabsorption leading to lack of good nutritional outcome]
• are on a prolonged nil-by-mouth period [eg. patients undergoing GI surgery]

DIGESTIVE DISORDERS:

• GI fistulae
• major GI surgery
• uncontrolled malabsorption [eg. in Chron’s Disease]
• short bowel syndrome [gastroschisis, volvulus & necrotising enterocolitis]
• severe enteropathy [genetic-related issues such as microvillus atrophy, tufting enteropathy, congenital, auto-immune]
• dysmotility or pseudo-obstruction
• severe acute pancreatitis

NON-DIGESTIVE DISORDERS:

• post-chemotherapy
• radiotherapy
• severe mucositis
• bone marrow transplant
• multi-organ failure in extensive trauma and burns
• immature gut

Contraindications for Total Parenteral Nutrition

• functioning GI tract [if the problem is with the upper GI tract and the lower GI tract is fully functioning, enteral feeding directly into the jenunum would be recommended]
• need for