TPN: Nursing Indications, Considerations, and Goals

Total parenteral nutrition (TPN) is a medical method that is given to patients, bypassing the gastrointestinal system. What are the causes why patients are placed on total parenteral nutrition?

In this section, we’ll be discussing the nursing indications, considerations, and goals, and everything there is to know about TPN.

Defining TPN

Total parenteral nutrition is primarily a patient’s entire nutrition in a bag. Inside every packet, there is an exact amount of calories that are necessary for the patient’s welfare. Total parenteral nutrition is usually given through a peripherally-inserted central catheter (PICC) line or a central venous catheter mainly due to TPN’s contents, which is very sugary and liquefied.

Nursing Considerations

When taking care of a patient who has a TPN line, healthcare providers, especially nurses, should give high regard to the following:

  1. The Nature of the Contents

Total parenteral nutrition is broken down food that is turned into a liquid form. It’s very thick and viscous which is why it is necessary to deliver it through either a PICC line or an essential venous catheter to have the contents introduced into the vein and have the body utilize it.

  1. The Type of Syringe

Due to the nature of its contents, total parenteral nutrition should be put through an 18 gauge syringe, intravenously. However, this risks the patient for infiltration and phlebitis because the vein has to endure too much TPN contents that it won’t have the capability to handle what is introduced and might burst.

Indications for TPN

Why do patients go on with total parenteral nutrition? This is usually because the patient has been on NPO for too long that the body is no longer receiving the right amount of nutrients required for proper functioning. Therefore, it is expected that these NPO patients will be given a particular type of sugar, commonly with D5 half normal saline.

What are the disorders or diseases that usually receive TPN?

  1. Patients with pancreatic abnormalities like pancreatitis. Eating can cause stress to the pancreas. Therefore, TPN is necessary.
  2. Ulcerative colitis patients are also given total parenteral nutrition.
  3. Patients who are suffering from small bowel obstructions and are unable to consume anything are also candidates for TPN.

The Main Goal

What’s the primary goal of providing total parenteral nutrition to patients? The primary purpose of the method is to maintain a positive nitrogen balance. But what does positive nitrogen balance mean?

Positive nitrogen balance means that the body is at an anabolic or growing state and not experiencing a catabolic breakdown situation. The intention is to keep the patient at a proper weight through adequate feeding, preventing deterioration.

Aside from keeping positive nitrogen balance, TPN also aims at:

  • Keeping the patient’s nutrition at a healthy state.
  • Preserving muscle mass; thus, lessening body fat.
  • Managing proper metabolism.
  • Sustaining continuous circulation inside the body.

Advantages of TPN

One of the main advantages of total parenteral nutrition is that it’s cost-effective, especially for medical institutions. Aside from that, TPN also decreases the risk for developing gut-related sepsis because the stomach is no longer used as the primary route for nutrition, especially with patients who have a small bowel obstruction or are on NPO.

In our next lecture, we’ll be talking more about TPN and how to wean off patients.