I.V. Essentials: Caring for your patient receiving TPN
Marcia K. Julian MSN, RN

Nursing Made Incredibly Easy!
February 2013 
Volume 11  Number 1
Pages 8 - 11
  PDF Version Available!

Nutrition is an essential component in the care of the critically ill patient. Adequate nutrition is required to meet the metabolic needs of the body, as well as facilitate healing. Malnutrition is common in hospitalized patients, with between 30% and 55% of patients being malnourished. Total parenteral nutrition (TPN) must be considered when the patient is malnourished and unable to obtain nutrients through the gastrointestinal (GI) tract, either orally or through enteral feedings, or when the patient is in a hypercatabolic state and requires additional nutrition to aid in healing.TPN is a mixture of proteins and carbohydrates, along with vitamins, minerals, and electrolytes, that are administered I.V. to provide complete nutrition. TPN is sometimes referred to as a 2-in-1 solution. A fat emulsion (lipids) is often given with TPN to prevent the occurrence of essential fatty deficiency and provide additional calories without adding to the risk of hyperglycemia. When the fat emulsion is added directly to the solution, it's called a total nutrient admixture, or a 3-in-1 solution.Although oral intake or enteral feeding is always preferred over parenteral nutrition to preserve the integrity and function of the gut, there are times when TPN is indicated. Patients with conditions affecting the function of the GI tract, such as paralytic ileus, obstruction, inflammatory bowel disease, or radiation enteritis, may require TPN, as well as patients who have increased metabolic needs, such as those with sepsis, cancer, or burns.Determining if TPN is indicated for your patient involves a thorough evaluation of the patient's nutritional status. Data such as the patient's dietary history, height and weight, body mass index, percentage of weight loss, primary diagnosis, comorbidities, and lab values (such as serum protein, albumin, transferrin, prealbumin, and retinol-binding protein) are all used to evaluate nutritional status and determine if TPN is indicated. Although the goal of

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