When preparing to infuse a bag of parenteral nutrition through a patients central line the nurse notices that the solution has coalesced what is his or her best response *?

What is TPN?

TPN stands for Total Parenteral Nutrition.  What does that mean?  Healthy individuals get their nutrition via the digestive tract, or the “enteral” route.  Thus, “parenteral” means that a route other than the digestive tract is used to obtain nutrition.  TPN is ordered for patients who, for whatever reason, cannot obtain adequate nutrition through their digestive tract.  This could be because of a blockage or a leak in the digestive tract.  Some patients have absorption issues as well, perhaps due to short bowel syndrome.  In short, when the digestive tract is not functional, TPN is necessary for patients to maintain adequate nutrition.

TPN is administered into a vein, generally through a PICC (peripherally inserted central catheter) line, but can also be administered through a central line or port-a-cath.  Patients may be on TPN for many weeks or months until their issues resolve.  Throughout the course of therapy, patients may or may not be able to ingest anything orally; whatever the case, they will not get any substantive nutrition via the oral route.

Because patients are not getting any other true form of nutrition, the TPN formula needs to contain all of the essential nutrients a body needs to be healthy.  This includes proteins, carbohydrates, fats, electrolytes, vitamins, and minerals.  There are standard formulations that are available, and these are often what are used by large hospital systems.  Infusion Solutions, however, batches each TPN formula to meet the individual dietary needs of the patient.  This leads to optimal nutrition and a better chance of restoring health.

The TPN formula is monitored by the Infusion Solutions team, including pharmacists, nurses, and dieticians.  The formula can be adjusted as necessary based on lab markers and the progress of the disease state.  The rate of TPN administration can also be changed under some circumstances.  Generally, patients are initially started on a continuous cycle and are given their TPN over a 24 hour period.  As patients progress, it may be possible to move to an 18, 15, or even a 12-hour infusion cycle.  This can certainly improve the quality of life for those patients managing this infusion at home.

The TPN itself comes in a 2-3 liter bag, and most patients infuse one bag per day.  The bag itself is connected to a portable infusion pump that has been pre-programmed by the pharmacy team to deliver the TPN over a specified amount of time.  The whole system fits nicely into a small backpack that can be worn by the patient or hung nearby throughout the infusion.  As with all home infusion therapies, the intent is for the patient to be as mobile as he or she would like to accommodate their lifestyle.

All therapies come with some inherent risk, and TPN is no different.  Caution must be taken to ensure that the PICC line and insertion site remain clean and free of infection.  Glucose abnormalities (hyper- or hypoglycemia) and liver dysfunction can also be a concern.  Patients on long-term TPN may be at risk for gall bladder inflammation and refeeding syndrome.  Essentially, there are issues that can arise when the digestive tract is not being used for prolonged periods of time, and so care is taken to mitigate or avoid these known complications.

Infusion Solutions has built a well-deserved reputation as this region’s foremost provider of TPN and other nutritional therapies.  If you have additional questions related to TPN or any other home infusion, please call our Bellingham office at 360-933-4892.  Additional resources can be found on our website: www.infusionsolutionsinc.com.