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    Total Parenteral Nutrition (TPN) : K.SAMINATHAN. M.pharm, M.B.A, (P.HD) Allianze College of Medical Sciences

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    samiveni
    The document discusses total parenteral nutrition (TPN), also known as total intravenous nutrition. TPN involves delivering nutrients directly into the bloodstream intravenously, bypassing the gastrointestinal tract. It can be delivered into a central or peripheral vein. TPN provides pre-digested forms of protein, carbohydrates, fats, electrolytes, vitamins and minerals to patients who cannot receive adequate nutrition by mouth or through enteral feeding tubes. The document outlines the components, indications, contraindications and guidelines for administering TPN.

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    Total Parenteral Nutrition (TPN) : K.SAMINATHAN. M.pharm, M.B.A, (P.HD) Allianze College of Medical Sciences

    Uploaded by

    samiveni
    177 views25 pages
    The document discusses total parenteral nutrition (TPN), also known as total intravenous nutrition. TPN involves delivering nutrients directly into the bloodstream intravenously, bypassing the gastrointestinal tract. It can be delivered into a central or peripheral vein. TPN provides pre-digested forms of protein, carbohydrates, fats, electrolytes, vitamins and minerals to patients who cannot receive adequate nutrition by mouth or through enteral feeding tubes. The document outlines the components, indications, contraindications and guidelines for administering TPN.

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    TOTAL PARENTERAL NEUTRITION

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    The document discusses total parenteral nutrition (TPN), also known as total intravenous nutrition. TPN involves delivering nutrients directly into the bloodstream intravenously, bypassing the gastrointestinal tract. It can be delivered into a central or peripheral vein. TPN provides pre-digested forms of protein, carbohydrates, fats, electrolytes, vitamins and minerals to patients who cannot receive adequate nutrition by mouth or through enteral feeding tubes. The document outlines the components, indications, contraindications and guidelines for administering TPN.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    177 views25 pages

    Total Parenteral Nutrition (TPN) : K.SAMINATHAN. M.pharm, M.B.A, (P.HD) Allianze College of Medical Sciences

    Uploaded by

    samiveni
    The document discusses total parenteral nutrition (TPN), also known as total intravenous nutrition. TPN involves delivering nutrients directly into the bloodstream intravenously, bypassing the gastrointestinal tract. It can be delivered into a central or peripheral vein. TPN provides pre-digested forms of protein, carbohydrates, fats, electrolytes, vitamins and minerals to patients who cannot receive adequate nutrition by mouth or through enteral feeding tubes. The document outlines the components, indications, contraindications and guidelines for administering TPN.

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    Total parenteral nutrition

    (TPN)

    BY

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    DEFINITION
    • Provision of all nutrition's through other than
    the alimentary tract

    • Parenteral nutrition is partial or total nutrition


    administered intravenously. A peripheral or
    central vein is used for access.

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    • Delivery of nutrients intravenously,
    e.g. via the bloodstream.

    – Central Parenteral Nutrition: often called


    Total Parenteral Nutrition (TPN); delivered
    into a central vein

    – Peripheral Parenteral Nutrition (PPN):


    delivered into a smaller or peripheral vein

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)
    Allianze college of medical sciences
    • Components are in elemental or
    “pre-digested” form

    – Protein as amino acids


    – CHO as dextrose
    – Fat as lipid emulsion
    – Electrolytes, vitamins and minerals

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    COMMON INDICATIONS FOR PN
    • Patient has failed EN with appropriate tube
    placement
    • Severe acute pancreatitis
    • Severe short bowel syndrome
    • Mesenteric ischemia
    • Paralytic ileus
    • Small bowel obstruction
    • GI fistula unless enteral access can be placed distal to
    the fistula or where volume of output warrants trial
    of EN

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    CONTRAINDICATIONS
    • Functional and accessible GI tract
    • Patient is taking oral diet
    • Prognosis does not warrant aggressive
    nutrition support (terminally ill)
    • Risk exceeds benefit
    • Patient expected to meet needs within 14
    days

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    VENOUS SITES FOR ACCESS TO THE SUPERIOR
    VENA CAVA

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)
    Allianze college of medical sciences
    Parenteral Nutrition

    • Macronutrients &
    • Micronutrients
    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)
    K.SAMINATHAN. M.pharm,
    Allianze college of medical M.B.A,(
    sciencesP.hD)
    Allianze college of medical sciences
    CARBOHYDRATE
    • Source: Monohydrous dextrose
    • Properties:
    Nitrogen sparing
    Energy source
    3.4 Kcal/g
    Hyperosmolar
    • Recommended intake:
    2 – 5 mg/kg/min
    50-65% of total calories

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    Macronutrients: Carbohydrate
    Potential Adverse Effects:
    • Increased minute ventilation
    • Increased CO2 production
    • Increased RQ
    • Increased O2 consumption
    • Lipogenesis and liver problems
    • Hyperglycemia

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    Macronutrients: Amino Acids
    • Source: Crystalline amino acids—
    standard or specialty
    • Properties: 4.0 Kcal/g

    Recommended intake:
    0.8-2.0 g/kg/day
    15-20% of total calories

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    Macronutrients:
    Amino Acids
    Potential Adverse
    Effects:
    • Increased renal
    solute load
    • Azotemia

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    Macronutrients: Amino Acids
    • Specialized Amino Acid Solutions
    Branched chain amino acids (BCAA)
    Essential amino acids (EAA)
    • Not shown to improve patient outcome
    • More expensive than standard solutions

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    Macronutrients: Lipids
    Requirements
    • 4% to 10% kcals given as lipid meets EFA
    requirements; or 2% to 4% kcals given as linoleic
    acid
    • Generally 500 mL of 10% fat emulsion given two
    times weekly or 500 mL of 20% lipids given once
    weekly will prevent EFAD
    • Usual range 25% to 35% of total kcals
    • Max. 60% of kcal or 2 g fat/kg
    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)
    Allianze college of medical sciences
    Macronutrients: Lipids
    Potential Adverse Effects:
    • Egg allergy
    • Hypertriglyceridemia
    • Decreased cell-mediated immunity (limit to
    <1 g/kg/day in critically ill
    immunosuppressed patients)
    • Abnormal LFTs

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    Other Requirements
    • Fluid—30 to 50 ml/kg (1.5 to 3 L/day)
    – Sterile water is added to PN admixture to
    meet fluid requirements
    • Electrolytes
    – Use acetate or chloride forms to manage
    metabolic acidosis or alkalosis
    • Vitamins: multivitamin formulations
    • Trace elements
    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)
    Allianze college of medical sciences
    Parenteral Nutrition Vitamin Guidelines
    Vitamin FDA Vitamin FDA
    Guidelines* Guidelines*
    A IU 3300 IU B2 mg 3.6
    D IU 200 IU B1 mg 6
    E IU 10 IU
    B6 mg 6
    K mcg 150 mcg
    B12 mg 5.0
    C mg 200
    Biotin mcg 60
    Folate mcg 600
    B5 dexpanthenol 15
    Niacin mg 40 mg

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    Daily Trace Element Supplementation for
    Adult PN
    TRACE ELEMENT INTAKE

    Chromium 10-15 mcg

    Copper 0.3-0.5 mg

    Manganese 60-100 mcg

    Zinc 2.5-5.0 mg

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    Daily Electrolyte Requirements Adult PN
    Electrolyte PN Equiv Standard Intake
    RDA
    Calcium 10 mEq 10-15 mEq
    Magnesium 10 mEq 8-20 mEq
    Phosphate 30 mmol 20-40 mmol
    Sodium N/A 1-2 mEq/kg + replacement
    Potassium N/A 1-2 mEq/kg
    Acetate N/A As needed for acid-base
    Chloride N/A As needed for acid-base
    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)
    Allianze college of medical sciences
    Two-in-One PN

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    PN Compounding Machines: Auto mix

    K.SAMINATHAN. M.pharm, M.B.A,( P.hD)


    Allianze college of medical sciences
    PN Compounding Machines: Micro mix

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