Total parenteral nutrition: A boon to non-functional gastrointestinal patients

Abstract

About 25 years ago it became apparent that TPN had value in the management of critically ill patients who were not being normally nourished because they either had gastrointestinal failure or could not tolerate the enteral preparations offered. Total parenteral nutrition (TPN) is a type of medication that provides nutrition to critically ill patients for whom enteral feeding is not possible. TPN is given through I.V route. Parenteral means outside of the digestive tract. TPN may be administered as peripheral parenteral nutrition (PPN) or via a central line, depending on the components and osmolality. TPN administered protein, fats, carbohydrates, vitamins and minerals. TPN plays a vital role in the growth and development of preterm neonates in NICU to provide micro nutrients, macro nutrients and electrolytes. TPN has extended the life of a small number of children born with non-existent or severely birth-deformed guts. Parenteral nutrition plays a major role in treating COVID-19 infection-related malnutrition in patients across the globe. Home parenteral nutrition (HPN) support has been an advancing therapy in the past 30 years. Patients who previously had no options to sustain their lives are now able to live at home, maintain employment, and continue with most daily activities. Although this therapy has been innovative and successful, it requires great financial and professional resources. Parenteral nutrition can be given for long periods of time. A large variety of complications can occur, related especially to the equipment or the nutrients. When the nutrition is given via a central venous catheter, then sepsis is a serious and possibly life-threatening complication. In case of administration via an arteriovenous shunt, thrombosis of the shunt is the most frequent problem.