Total parenteral nutrition

Basics

Commonly used in nutritionally compromised surgical patients
Bags contain combinations of glucose, lipids and essential electrolytes, the exact composition is determined by the patients nutritional requirements.
Although it may be infused peripherally, this may result in thrombophlebitis.
Longer term infusions should be administered into a central vein (preferably via a PICC line).

Complications

Infectious
- Catheter-related bloodstream infections (CRBSIs)
- Sepsis from central line contamination
Metabolic
- Hyperglycaemia or hypoglycaemia
- Electrolyte disturbances
- Refeeding syndrome: Sudden intracellular shift of electrolytes when feeding is restarted in malnourished patients - the hallmark feature is hypophosphataemia. Hypokalaemia and hypomagnesaemia may also occur
Hepatobiliary
- Fatty liver (hepatic steatosis)
- Cholestasis
- Gallstones
- Long-term liver fibrosis
Mechanical / Vascular
- Pneumothorax, catheter malposition
- Venous thrombosis
- Thrombophlebitis (especially with peripheral TPN)
Nutritional / Bone
- Vitamin and trace element imbalances
- Metabolic bone disease (osteopenia/osteoporosis)

+PassMedicine Notes

Basics

Commonly used in nutritionally compromised surgical patients
Bags contain combinations of glucose, lipids and essential electrolytes, the exact composition is determined by the patients nutritional requirements.
Although it may be infused peripherally, this may result in thrombophlebitis.
Longer term infusions should be administered into a central vein (preferably via a PICC line).

Complications

Hyperglycaemia or hypoglycaemia
Electrolyte disturbances
Refeeding syndrome: Sudden intracellular shift of electrolytes when feeding is restarted in malnourished patients - the hallmark feature is hypophosphataemia. Hypokalaemia and hypomagnesaemia may also occur

Saved ✓