Total parenteral nutrition (TPN), also
called hyperalimentation, is the practice of feeding a person without using the
gut. It is normally used during surgical recoveries. It has been used for
patients in coma, although enteric (tube) feeding is usually adequate, and less
prone to complications. Chronic TPN is occasionally used to treat people suffering
the extended consequences of an accident or surgery. Most controversially, TPN
has extended the life of a small number of children born with nonexistent or
severely birth-deformed guts. The oldest were eight years old in
In TPN's simplest form, a bag of nutrients
is added to a patient's intravenous drip.
The preferred method of performing TPN is
with a medical infusion pump. A sterile bag of nutrient solution, between 500ml
and 4l is provided. The pump infuses a small amount (0.1 to 10ml/hr)
continuously in order to keep the vein open. Feeding schedules vary, but one
common regimen ramps up the nutrition over a few hours, levels off the rate for
a few hours, and then ramps it down over a few more hours, in order to simulate
a normal set of meal times.
The nutrient solution consists of water,
glucose, salts, amino acids, vitamins and (more controversially) sometimes
emulsified fats. Long term TPN patients sometimes suffer from lack of trace
nutrients or electrolyte imbalances. Because increased blood sugar commonly
occurs with TPN, insulin may also be added to the infusion. Occasionally, other
drugs are added as well.
Chronic TPN is performed through a Hickman
line or a Port-a-Cath (venous access systems), or sometimes through an artery.
Arterial shunts are more dangerous, but sturdier because an artery wall is more
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