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What Is TPN?

Nutrients can be provided to a patient via IV in TPN, or total parenteral nutrition.
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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 24 March 2014
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Total parenteral nutrition (TPN) is a form of feeding in which all nutritional needs are met with a solution which is infused into the veins. This feeding technique is only used in very specific settings, and care providers usually try to make sure that TPN is only used in the short term. However, patients can and have received TPN for decades in cases where this is necessary.

The most common reason to use TPN is because the gastrointestinal tract is nonfunctional. In the case of a premature infant, this may be because it's not fully formed yet. For adults, it can be the result of complications of disease or severe trauma. People such as cancer patients, burn victims, and AIDS patients sometimes require TPN.

The biggest risk with this feeding method is a bacterial infection caused by leaving a catheter in place to provide the nutrition. The catheter needs to be meticulously cared for, and it is critical that it be used only for TPN, with any other fluids and medications being delivered through a different catheter. Some people who require this form of nutrition in the long term can develop gallstone and liver problems, as well, and it is important to monitor for these.

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If the gastrointestinal tract is at all functional, a doctor will recommend partial parental nutrition in preference to TPN. This is because it is important to keep the GI tract in use; it can atrophy if not utilized. With partial parenteral nutrition, patients take some food by mouth or through a stomach tube, and receive other nutrients through an intravenous line. Patients may also be weaned from TPN in this way, giving their bodies time to adjust rather than thrusting them back onto a diet in which all their nutrition is derived through the digestive tract.

In some cases, people who still require TPN may be sent home, because they are otherwise fully healthy and do not require hospitalization. The patient will be given directions in handling feedings and caring for the catheter, and will be given a supply of IV bags which are ready for use. The patient and his or her care providers will also learn about programming the infusion pump which is usually used to deliver total parenteral nutrition. People who require long term TPN do need to make sure that they monitor closely for complications, but may not have other restrictions on their lifestyles or activity levels.

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Discuss this Article

anon316724
Post 8

My son has been at home for a year on tpnas. He is in full bowel failure, we cope well and he is doing remarkably well. Obviously, the long term effects of tpn are serious problems with the liver, but I'm just pleased to be able to care for him at home where he belongs.

May I just ask the lady on a previous post who says her dad has lost his outside independence because of being on tpn 10 hours a day? My son is fed 14 hours over night so we have the days to live as normal as possible. I suggest you speak to his specialist and see if this is an option.

anon259416
Post 7

Any ideas on how to get TPN paid for in the home? I work in long term care, and have a patient who would like to go home but medicare is balking at paying for TPN in the home (it would be much cheaper I'm sure). She is receiving TPN in building. She's great otherwise, walking and doing most things for herself. Medicare wants to make sure it is really medically necessary and refuses to pay for the care in the home, until we can prove it is medically necessary. Huh?

It's not enough, apparently, that her MD says it's necessary. Another crazy aspect of government in action.

goldenbears
Post 6

@SuperJD - Thank you for sharing your situation. It is great to know that other families are dealing with the same issue that mine is. I definitely sympathize with you and your family.

After a horrible car accident, my 12 year old daughter could not digest her food properly, amongst several other complications. She was forced to spend about six weeks in the hospital, After the rest of her body had healed, the doctor sent her home with a TPN care kit. Her bowel had been completely crushed, and the doctor said it would take over six months to heal.

At first, it was hard for her, and the rest of the family to adjust to her situation. We were forced to take her out of school temporarily, and enrolled her in a home school network in our community. She loves to play soccer, she was heartbroken when she was forced to sit a season out.

However, I encouraged her to take up another hobby, one that she could do while she was at home feeding. She chose the piano, and I must say, she is getting really good!

The doctors hope she will make a full recovery within the next few weeks. For now, her strength and resilience is getting her through this tough situation.

SuperJD
Post 5

My 67 year old dad was recently placed on TPN. His colon was deteriorating, and he could no longer properly digest food. He was hospitalized for about a month before the doctor sent him home, with his TPN fluids, IV needles and long list of instructions.

Although I am thankful that my dad is still here with me and my family, his quality of life has greatly decreased because of his TPN treatments.

He used to be quite an outdoors man, and loved to fish and hike. Now, however, he is forced to stay home all the time, since his feeding takes ten hours a day, five days a week. It breaks my heart to see him like this, and he is constantly reminiscing of the days he spent in what he called "the outstanding outdoors".

I wonder how other families are coping with their loved one's sudden change in lifestyle.

Oski
Post 4

@sehiggins - I am glad you brought up blood clotting. It is a very serious risk that affected my nephew as a baby.

My younger sister had a very complicated pregnancy. Her unborn baby was causing her own health to be in danger, so her doctor had to induce her into having her baby early. She had only be pregnant for a little over six months. Needless to say, the baby boy was not as developed as he should have been.

To keep a long story short, the doctor had to place him on a total parenteral nutrition feeding plan. The doctor was very clear in explaining the possible complications associated with TPN, but he failed to mention blood clotting.

Ironically, blood clotting is what my nephew suffered from. He was having trouble breathing a few weeks after his birth, and the doctors discovered a clot in his left lung. We learned that the clot was associated with his TPN IV line.

My nephew is fine now, but I wish the doctor would have been more thorough with listing the complications, because that blood clot gave us quite a scare.

sehiggins
Post 3

This is a very helpful article! I am a medical student, so I look up information that relates to medicine all the time. I am glad I stumbled across this one.

I would like to add, though, that another possible and dangerous side effect in using total parental nutrition is blood clots forming in the veins.

Based on the nature of TPN, an IV is inserted into a person's veins for a long period of time. This foreign object placed into any vascular system can cause a blood clot to form around the IV line.

If a blood clot does develop, the real danger lies in the fact that the clot can break off the IV line, and travel through the veins and into the lungs. Once in the lungs, a number of things can go wrong, including the death of a patient.

It is important that all patients, but especially those that have a history of blood clotting, make sure that their doctor is monitoring the veins around the IV line. If clots are caught earlier, they can be broken up and save a life!

SailorJerry
Post 2

My uncle was on TPN because of complications from Crohn's disease (a nasty problem inflammatory bowel disease). The idea was that by being on tpn just for a while, his bowel could rest and heal. I suppose it did help; he said he felt better than he had in years while he was on it. Unfortunately, it's only a temporary benefit and his symptoms returned when it stopped the tpn. Poor guy is just as gaunt as can be because his intestines can't absorb nutrients properly.

MrsWinslow
Post 1

Maybe an adult could be sent home on total parenteral nutrition, but a premature baby definitely won't be! My best friend had a preemie and being able to eat was definitely one of the milestones the doctors look for.

Her baby was on TPN for I think just a few days. Then what they do is slowly switch from TPN to formula or expressed breastmilk (at this point, her baby was still too weak to suck).

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