Total parenteral nutrition ( PN ) is feeding a person intravenously, through normal eating and digestion processes. The person receives nutritional formula that contains nutrients such as glucose, salt, amino acids, lipids and supplemental vitamins and dietary minerals. This is called total parenteral nutrition ( TPN ) or total nutrient mixture ( TNA ) when no significant nutrient obtained. by another route, and partial parenteral nutrition ( VAT ) when the nutrients are also partially enteric. This can be called peripheral parenteral nutrition ( VAT ) when administered through venous access in the extremities rather than through the central vein as central venous nutrition ( CVN ).
Video Parenteral nutrition
Medical use
Total parenteral nutrition (TPN) is given when the gastrointestinal tract is not functioning due to disturbance in continuity (blocked, or has a leak - fistula) or due to its absorptive capacity is impaired. It has been used for coma patients, although enteral feeding is usually preferred, and less prone to complications. Parenteral nutrition is used to prevent malnutrition in patients who are unable to obtain adequate nutrition via oral or enteral routes.
Gastrointestinal disorders
TPN may be the only viable option to provide nutrition to patients who do not have a functioning gastrointestinal tract or who have disorders that require complete intestinal rest, including bowel obstruction, short bowel syndrome, gastroschisis, prolonged diarrhea regardless of the cause, severe Crohn's disease. or ulcerative colitis, and certain childhood GI disorders including congenital GI abnormalities and necrotizing enterocolitis.
In cancer
The benefits of TPN for cancer patients are largely disputed, and studies to date generally show minimal long-term benefits. On the other hand, there is no evidence to support the idea that intravenous nutrition 'feeds cancer, not patients'.
Maps Parenteral nutrition
Duration
Short-term PN may be used if a person's digestive system has been closed (eg by peritonitis), and they are at a low enough weight to cause concerns about nutrition during extended hospital stay. Long-term PN is sometimes used to treat people suffering the extended consequences of accidents, surgery, or indigestion. PN has extended the lives of children born with organs that do not exist or are severely disabled.
Stay with TPN
Approximately 40,000 people use TPN at home in the United States, and because TPN requires anywhere from 10-16 hours to be delivered, everyday life can be affected. Although everyday lifestyle can be changed, most patients agree that this change is better than staying in a hospital. Many different types of pumps to limit the time the patient is "connected". Usually a backpack is used, allowing mobility. The time it takes to connect to IV depends on the situation of each patient; some require one time a day, or five days a week.
It is important for patients to avoid as many TPN changes as possible in their lifestyle. This allows for the best mental health situation; persistent detention can lead to hatred and depression. Physical activity is also highly recommended, but patients should avoid contact sports (equipment damage) and swimming (infection). Many teenagers find it difficult to live with TPN due to issues of body image and can not participate in activities and events.
Complications
TPN completely passes through the digestive tract and normal methods of nutrient absorption. Possible complications, which may be significant, are listed below.
Infection
TPN requires chronic IV access to the solution to run, and the most common complication is this catheter infection. Infection is a common cause of death in these patients, with a mortality rate of about 15% per infection, and death usually results from septic shock.
Blood clotting
Chronic IV access leaves a foreign object in the vascular system, and blood clots in this line of infusion are common. Death can occur due to pulmonary embolism in which clumps that begin on the IV line break and move into the lungs, blocking blood flow.
Patients on TPN who have such clumps that cover their catheters can receive thrombolytic flush to dissolve clots and prevent further complications.
Liver and liver failure
Fatty liver is usually a long-term complication of TPN, although over a considerable period of time it is quite common. Pathogenesis is due to use linoleic acid (omega-6 fatty acid component of soybean oil) as the main source of calories. TPN-related liver disease affects up to 50% of patients within 5-7 years, correlating with 2-50% mortality. The onset of this liver disease is a major complication that causes TPN patients to require intestinal transplantation.
Intralipid (Fresenius-Kabi), the standard US lipid emulsion for TPN nutrition, contains a ratio of 7: 1 to n-6/n-3 ratio of polyunsaturated fatty acids (PUFAs). In contrast, Omegaven has a 1: 8 ratio and shows promise in various clinical studies. Therefore, n-3-rich fat may alter the course of liver diseases associated with parenteral nutrition.
Hungry
Because patients are fed intravenously, the subjects do not eat physically, causing an overwhelming hunger. The brain uses signals from the mouth (taste and smell), stomach/G.I. channel (fullness) and blood (nutrient levels) to determine the feeling of consciousness of hunger. In the case of TPN, the requirements of taste, odor and physical fulfillment are not met, and so the patient experiences hunger, despite the fact that the body is being fully nourished.
Patients who eat food though unable to experience various complications.
Cholecystitis
Total parenteral nutrition increases the risk of acute cholecystitis due to incomplete gastrointestinal tract, which can lead to bile stasis in the gallbladder. Other potential hepatobiliary dysfunctions include steatosis, steatohepatitis, cholestasis, and cholelithiasis. Six percent of patients on TPN were longer than 3 weeks and 100% of patients on TPN longer than 13 weeks developed biliary sludge. The formation of sludge is the result of stasis due to lack of enteric stimulation and not due to changes in bile composition. Gallic gallbladder disappears after 4 weeks of a normal oral diet. The administration of exogenous cholecystokinin (CCK) or endogenous CCK stimulation by periodic pulses of a large number of amino acids has been shown to help prevent the formation of sludge. These therapies are not recommended routinely. Such complications are suggested to be the main reason for death in people who need long-term total parenteral nutrition, such as short bowel syndrome. In newborns with short bowel syndrome with less than 10% of expected intestinal length, thus depending on total parenteral nutrition, 5-year survival is about 20%.
Atrophy
Babies who survive on TPN without food through the mouth for long periods are at risk for developing intestinal atrophy.
Other complications
Other complications are associated with catheter, or metabolic insertion, including refeeding syndrome. Complications of the catheter include pneumothorax, unintentional arterial puncture, and catheter-related sepsis. The rate of complications at the time of insertion should be less than 5%. Infections associated with catheters can be minimized with a choice of catheters and proper insertion techniques. Metabolic complications include refeeding syndrome characterized by hypokalemia, hypophosphatemia and hypomagnesemia. Hyperglycaemia often occurs early in therapy, but can be treated with insulin added to the TPN solution. Hypoglycemia may occur with sudden termination of TPN. Liver dysfunction may be confined to reversible cholestatic jaundice and fat infiltration (indicated by high transaminase). Severe liver dysfunction is a rare complication. Overall, patients receiving TPN had higher rates of infection complications. This can be linked to hyperglycemia.
Pregnancy
Pregnancy can cause major complications when trying to dose the right nutrients. Since all baby food comes from the mother's bloodstream, the physician should calculate the nutritional dosage to meet the needs of the recipient and request it in usable form. Incorrect doses can cause many harmful and unpredictable effects, such as death, and various degrees of deformation or other developmental problems.
It is recommended that parenteral nutrition begins after a period of natural nutrition so that physicians can precisely quantify the nutritional needs of the fetus. Otherwise, it should only be managed by a team of highly skilled doctors who can accurately assess the needs of the fetus.
Total parenteral nutrition
Solutions for total parenteral nutrition can be tailored to individual patient needs, or standard solutions can be used. The use of standard parenteral nutrition solutions is cost effective and can provide better control of serum electrolytes. Ideally each patient is individually assessed before starting on parenteral nutrition, and teams of specialized doctors, nurses, clinical pharmacists and registered dietitians evaluate individual patient data and decide which PN formula to use and how much infusion rate.
For energy alone, intravenous sugar solutions with dextrose or glucose are commonly used. It is not considered parenteral nutrition because it does not prevent malnutrition when used alone. The standard solution may also differ between developers. Here are some examples of what compositions they have. Solutions for normal patients can be given centrally and peripherally.
Components
Ready-made solutions
The prepared solution generally consists of water and electrolyte; glucose, amino acids, and lipids; essential vitamins, minerals and additional elements are added or given separately. Previous lipid emulsions were given separately but this is becoming more common for "three in one" solution of glucose, protein, and lipids for administration.
Add components
Individual nutritional components can be added to more precisely adjust the body content. The individual nutrients may, if possible, be infused individually, or may be injected into the bag of nutrient solution or intravenous fluid (volume expander solution) administered to the patient.
The administration of individual components may be more dangerous than providing a pre-mixed solution as used in total parenteral nutrition, since the latter is generally well-balanced in terms of for example. osmolarity and the ability to implant peripheral. Inappropriate IV potassium may be lethal, but it is harmless if potassium is mixed in a TPN solution and diluted.
Vitamins can be added to the major pre-dermal nutrients before administration, because additional vitamins can increase the decay of stored products. Vitamins can be added in two doses, one soluble in fat, the other soluble in water. There is also a single dose preparation with fat and water soluble vitamins like Cernevit .
Minerals and trace elements for parenteral nutrition are available in prepared mixtures, such as Addaven .
Emulsifier
Only a number of emulsifiers which are generally considered safe for parenteral administration, the most important is lecithin. Lecithin can be decomposed and metabolized, as it is an integral part of the biological membrane, making it virtually non-toxic. Other emulsifiers can only be excreted through the kidneys, creating a toxic load. The preferred emulsifier for most of the fat emulsions used for parenteral nutrition is the highly purified egg lecithin, due to its low toxicity and complete integration with the cell membrane.
Use of egg-derived emulsifiers is not recommended for people who have egg allergies because of the risk of reactions. In situations where no emulsifying agent is suitable for someone at risk of deficiency of essential fatty acids, cooking oil may spread to most of the skin available for supplementation with transdermal absorption.
Another type of Omegaven fat emulsion is being used experimentally in the US especially in pediatric populations. It is made from fish oil, not an egg-based formula more widely used. Studies have shown the use of Omegaven can reverse and prevent liver disease and cholestasis.
History
Developed in the 1960s by Dr. Stanley J. Dudrick, who as a resident of surgery at the University of Pennsylvania, who works in the basic science laboratory. Jonathan Rhoads, was the first to successfully breed a Beagle puppy at first and then a newborn with catastrophic disease. gastrointestinal malignancy. Dr. Dudrick collaborated with Dr. Willmore and Dr. Vars to complete the work required to make these nutritional techniques safe and successful.
See also
- Food tube
- Hickman Lines
- Intradialitian parenteral nutrition
- Intravenous therapy
References
External links
- American Society for Parenteral and Enteral Nutrition
- Oley Foundation for people who feed through tubes or IV at home
- Nutrishare Specialist in long-term home parenteral nutrition in the United States
- Counting Parenteral Feeds at California State University, San Bernardino
- UK-based support group PINNT for Intravenous and Nasogastric Nutrition Therapy Patients
- Nieman, Liesje (January 2008). "Parenteral Nutrition at NICU" (PDF) . NutritionDimension.com . Retrieved April 16 2013 .
Code Course ID: PNN07
- Kimaya web app to calculate TPN
- Calea provides parenteral nutrition services (HPN) for patients in England and Wales]
Source of the article : Wikipedia
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