what is total parenteral nutrition and what Te the major Contraindications of parenteral nutrition?
Total parenteral nutrition definition, Types of total parenteral nutrition as the nutrition taken through the central vein, which is the nutritional alternatives and nutritional supplements necessary for the body to carry out its functions in the form of a solution as full or Partial parenteral nutrition.
Parenteral nutrition, also known as intravenous nutrition, is a method of providing nutrients to individuals who cannot consume adequate nutrition orally or enterally (through the digestive system).
Good nutrition provides a mechanism to promote health and prevent disease, chemistry, physiology, and medicine
Disease is defined as any abnormal condition affecting the health of an organism, and is characterized by specific signs and symptoms
The Recommended Daily Allowance (RDA) of total parenteral nutrition was published in response to poor diet in many Americans, to determine the daily calorie requirement for your body
TPN may be used in various clinical situations, including:
- Severe Malnutrition:
- Gastrointestinal Dysfunction:
TPN is used when the gastrointestinal tract is dysfunctional, such as in cases of intestinal obstruction, short bowel syndrome, severe inflammatory bowel disease, or high-output enterocutaneous fistulas.
- Gastrointestinal Rest:
TPN can provide bowel rest by bypassing the digestive system, allowing the intestines to heal in certain conditions like severe pancreatitis, intestinal ischemia, or bowel surgeries.
- Intractable Vomiting or Diarrhea:
TPN may be necessary when a patient experiences persistent vomiting or diarrhea, making enteral nutrition impossible or inadequate.
- Hypermetabolic States:
TPN is employed in patients with increased nutrient requirements due to hypermetabolic conditions, such as severe burns, major trauma, or critical illness.
- Preoperative or Postoperative Nutrition:
TPN may be used before or after surgery when the patient’s nutritional needs cannot be met through oral or enteral routes alone.
TPN requires close monitoring by healthcare professionals, as it carries potential complications such as infection, metabolic disturbances, liver dysfunction, and electrolyte imbalances.
Therefore, it is typically administered in a hospital setting under the supervision of a multidisciplinary team comprising physicians, dietitians, and pharmacists who tailor the TPN formulation and monitor its effects closely.
It’s important to note that TPN is typically considered a last resort when other forms of nutrition delivery are not feasible or adequate. Whenever possible, enteral nutrition (feeding through the digestive system) is preferred due to its associated benefits, including preservation of gut function, reduced risk of infections, and improved outcomes.
People’s caloric needs as energy sources
These components are carefully formulated based on the individual’s specific nutritional needs, taking into account factors such as age, weight, underlying medical conditions, and metabolic requirements.
- 45%-65% Carbohydrates provide 4 calories, Glucose is a major energy component the body uses.
- 20%-35% fat, which provides 9 calories. The basic structure is a 3 C glycerol molecule with fatty acid attached to each C- triglyceride
- 10%-35% protein, which supplies 4 calories, is Used for structure in the body.
The percentages of calories needed by adults are the same as in children. But the needs of calories increase during illness, as in cases of fever and other cases.
To form an integrated diet meal, it must consist of all macro and micronutrients, such as carbohydrates, fats, protein, water, and micronutrients such as vitamins and minerals.
Types of total parenteral nutrition
Total Parenteral Nutrition (TPN) can be tailored to meet the specific nutritional needs of individual patients. The components of TPN are customized based on factors such as the patient’s age, weight, underlying medical condition, and metabolic requirements it can be Partial parenteral nutrition. Here are the main components that can be included in TPN:
- Macronutrients: a.
Carbohydrates (Glucose): Glucose is the primary source of energy in TPN. It is provided in the form of dextrose monohydrate, and the concentration can vary depending on the patient’s needs. b. Proteins (Amino Acids): Amino acids are essential for tissue repair, growth, and maintenance. Various formulations of amino acids are available, and the selection depends on the patient’s specific requirements.
- Lipids:
Intravenous lipids are a source of essential fatty acids and provide additional calories. Commonly used lipid sources include soybean oil, olive oil, and fish oil. Lipids are usually added to the TPN bag separately and administered separately from the glucose and amino acids.
- Vitamins:
TPN formulations include a wide range of essential vitamins, including fat-soluble vitamins (A, D, E, and K) and water-soluble vitamins (B-complex vitamins and vitamin C). The specific vitamin composition is adjusted based on the patient’s needs and any underlying deficiencies.
- Minerals and Trace Elements:
TPN solutions contain various minerals and trace elements necessary for normal physiological functions. These include sodium, potassium, magnesium, calcium, phosphorus, zinc, copper, selenium, and others. The concentration of each mineral is carefully regulated based on the patient’s requirements and regular monitoring of electrolyte levels through Partial parenteral nutrition.
- Electrolytes:
TPN formulations also include electrolytes such as sodium, potassium, chloride, and phosphate. These electrolytes help maintain fluid balance, and acid-base balance, and support normal cellular functions.
It’s important to note that TPN formulations are typically prepared by specialized compounding pharmacies or under the guidance of clinical pharmacists and nutrition support teams. They adhere to strict quality control measures and sterile compounding techniques to ensure the safety and accuracy of the TPN solution.
Carbs
- are chemical components that provide the body with the form of sugars that provide 4 calories, and the daily need for an adult is 250-300 grams.
Fats
- including necessary and non-essential fats for the body, and the daily requirement of them is 50-70 grams-Saturated fats- usually from animals, solid at room temp.-Unsaturated fats- usually from plants, liquid at room temp
Proteins
- consist of amino acids, including the essential ones that not create in the body and the non-essential ones, and the need for them is 0.8 grams per kilogram of a person’s weight.
fluid
- (water) has a daily requirement of about two liters or more
- such as vitamins and minerals supplied to the body to maintain metabolic activity
After parenteral nutrition(TPN)definition is given, as a liquid solution in the blood through a vein to patients who suffer from digestive problems, also in cases of dehydration, or who are unable to eat food. It provides calories and nutrients that the patient needs.
Types of solutions, Types of total parenteral nutrition
- normal saline In the event of a pressure drop
- hypertonic saline treat hyponatremina
- ringer for rehydration
- glucose source of nutrients
some medical treatmentÂ
- vitalipd full of vitamins and minerals A-D-E-K and phospholipids
- Soluvit vitamin B and C and glycine
- addamel Fe and Zn- Mn
- intralipid 1.1 kcal
- Aminoven contain amino acids
Contraindications of parenteral nutrition
While parenteral nutrition can be life-saving, it also carries certain contraindications or situations where it may not be appropriate or safe to administer. Here is some common Discontinuing parenteral nutrition:
- Intact Gastrointestinal Tract:
Parenteral nutrition is generally contraindicated when the gastrointestinal (GI) tract is fully functional and can adequately absorb and utilize nutrients. In such cases, enteral nutrition (feeding through the digestive system) is preferred over parenteral nutrition.
- Short-Term Nutritional Support:
Parenteral nutrition is typically reserved for patients who require long-term or prolonged nutritional support. If the patient only requires short-term nutritional supplementation or can tolerate enteral nutrition, parenteral nutrition may not be necessary.
- Stable Enteral Access:
If the patient has a functioning enteral access route, such as a feeding tube, that can deliver adequate nutrition, parenteral nutrition may not be indicated. Enteral nutrition is generally preferred due to its lower risk of complications.
- Malabsorption Syndromes:
Parenteral nutrition may be contraindicated in certain malabsorption syndromes where the gastrointestinal tract cannot absorb nutrients properly. However, in some cases, a combination of enteral and parenteral nutrition may be necessary.
- Bowel Obstruction or Fistula:
Patients with complete bowel obstruction or uncontrolled gastrointestinal fistulas may not be suitable candidates for parenteral nutrition. These conditions often require surgical intervention or specific management approaches.
- Unstable Hemodynamics:
Parenteral nutrition can impact fluid and electrolyte balance, particularly in patients with unstable hemodynamics. In such cases, careful monitoring and stabilization of the patient’s condition are necessary before considering parenteral nutrition.
- Severe Liver Dysfunction:
In patients with severe liver dysfunction, the administration of parenteral nutrition can worsen the liver’s metabolic burden and may not be recommended. Alternative approaches, such as specialized enteral formulas or partial parenteral nutrition, may be considered.
- Untreatable Sepsis:
If a patient has uncontrolled or untreatable sepsis (severe infection), parenteral nutrition may be contraindicated due to the risk of exacerbating the infection or causing other complications. In such cases, supportive care and appropriate antimicrobial therapy are the main focus.
the common complication of Total Parenteral Nutrition
The most common complication of Total Parenteral Nutrition (TPN) is an infection, particularly bloodstream infections, also known as catheter-related bloodstream infections (CRBSIs). These infections occur when bacteria or other microorganisms enter the bloodstream through the central venous catheter used for TPN administration. CRBSIs can lead to serious complications and significantly impact patient outcomes.
Several factors contribute to the increased risk of infection associated with TPN:
- Catheter Placement:
The insertion and maintenance of the central venous catheter provide potential opportunities for microbial contamination and subsequent infection. Strict sterile techniques during catheter insertion and proper catheter care are crucial to minimize the risk. - Prolonged Catheter Use:
The duration of catheter use is directly related to the risk of infection. The longer the catheter remains in place, the higher the likelihood of infection. Frequent catheter changes and adherence to aseptic protocols are essential to reduce this risk. - Breaks in Aseptic Technique:
Any breach in the aseptic technique during catheter access, medication administration, or TPN preparation and administration can introduce microorganisms and increase the risk of infection. - Skin Contamination:
The skin surrounding the catheter exit site is a potential source of infection. Proper hygiene, regular cleaning, and appropriate dressing changes are necessary to maintain skin integrity and minimize the risk of contamination.
It’s important to note that the decision to initiate parenteral nutrition should always be made by healthcare professionals based on an individual patient’s specific condition, overall clinical status, and nutritional needs. The contraindications can vary depending on the patient’s unique circumstances, and careful evaluation and monitoring are necessary to ensure the best possible outcome for different Types of total parenteral nutrition.
