Parenteral nutrition is a specialized form of intravenous (IV) therapy for patients who cannot adequately absorb nutrients through the digestive tract, often due to severe gastrointestinal conditions or surgeries. This therapy provides essential nutrients, including proteins, carbohydrates, fats, vitamins, and minerals, directly into the bloodstream via a catheter, bypassing the digestive system entirely.
A healthcare team, typically including doctors and nutrition specialists, customizes the nutrient formula and determines the most suitable catheter type based on individual needs. There are two main catheter options for administering parenteral nutrition:
- Tunneled CVCs/Non-tunneled CVC: These catheters have external segments outside the skin and another portion tunneled beneath the skin, helping secure the line and reducing infection risk before it enters a major vein. It is commonly chosen for patients needing long-term parenteral nutrition.
- Implanted Port: This option is inserted entirely under the skin, where the port can be accessed with a needle during each treatment session. This approach is often preferred for patients who require periodic or long-term therapy but wish to minimize visible equipment and reduce maintenance between infusions.
There are several types of parenteral nutrition infusion therapies:
Total Parenteral Nutrition (TPN)
TPN is a comprehensive form of parenteral nutrition that provides all the nutrients a patient needs intravenously
Key features include:
- Administered through a central vein, typically the subclavian vein or superior vena cava
- Contains a mixture of carbohydrates, proteins, fats, electrolytes, vitamins, and minerals
- Usually given continuously
- Can be tailored to meet individual nutritional needs
- Used when the digestive system needs to rest and heal or cannot absorb nutrients properly
Peripheral Parenteral Nutrition (PPN)
PPN is a less concentrated form of parenteral nutrition administered through peripheral veins, usually in the arms
Characteristics of PPN include:
- Used for short-term nutritional support (typically less than two weeks)
- Less invasive than TPN
- Not recommended for long-term use due to risk of vein irritation and infection
- Suitable for patients who need some nutritional support but are not severely malnourished
Home Parenteral Nutrition (HPN)
HPN allows patients to receive parenteral nutrition at home rather than in a hospital setting
Key aspects include:
- Administered by trained healthcare professionals, patients, or caregivers
- Requires careful monitoring for complications like infections or blood clots
- Necessitates regular follow-up visits with healthcare providers
- Can be used for extended periods, sometimes lifelong
Cycled Parenteral Nutrition (CPN)
This method involves administering parenteral nutrition over specific time periods rather than continuously
Benefits of cycled PN include:
- Allows patients time off the pump for increased mobility and activity
- Can promote feelings of hunger, making transition to oral feeding easier
- May promote a more natural hormone response similar to regular meals
Parenteral nutrition is a vital therapy tailored to each patient’s unique needs, providing essential nutrients directly into the bloodstream when traditional feeding methods aren’t possible. This therapy supports patients’ health, aids recovery, and enhances quality of life by delivering the critical nutrition they need.
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References
Nickel, B. et al., (2024, January/ February) Infusion Therapy Standards of Practice 9th edition. Journal of Infusion Nursing. https://www.ins1.org/publications/infusion-therapy-standards-of-practice/
Sievert, D. (2023, March 20) Malnutrition Treatment – Feeding Tube vs. IV Nutrition. UCLA Health. https://medschool.ucla.edu/news-article/malnutrition-treatment-feeding-tube-vs-iv-nutrition
Mayo Clinic. (2017, December 23) Home Parenteral Nutrition. https://www.mayoclinic.org/tests-procedures/total-parenteral-nutrition/about/pac-20385081
Aspen. What Is Parenteral Nutrition?. https://www.nutritioncare.org/About_Clinical_Nutrition/What_Is_Parenteral_Nutrition_/