Banana Bag vs TPN vs PPN

[Brimurph2009]

Hello fellow nurses!So I am wondering what are the different components or medications in each bag? Particularly Banana Bag and TPN. I ask this because I have a cancer pt that is dehydrated r/t poor intake and appetite.. the ER dr wanted to infuse a banana bag but then the hospitalist cancelled it and said, "the pt is not an alcaholic". I understand that a banana bag is more loaded with vitamins (which an alcoholic would lack like thiamine) but why wouldn't someone with poor intake, dehydration, etc. be a candidate for a banana bag? Im just confused as to when one would be used over the other vs. what is also in each bag. Also, is TPN and PPN the same thing but used in a different vascular access? Thanks in advance for the help :) Hope everyone isn't working too hard-- LOL imagine that! A nurse not working too hard -Britt

[JustBeachyNurse, LPN]

Banana bag is multivitamin IV plus thiamine. No calories. No carbohydrates. No fats. No protein. TPN is total parenteral nutrition & can be customized for a patient's needs. It has nutrients, carbohydrates, proteins and lipids may be included or hung separately. TPN is a patient's sole source of nutrition when oral, GT or JT is not an option.

PPN and TPN are similar but definitely not the same. Lipids and higher osmolarity preparations cannot be administered peripherally.

Here's a tutorial.

Parenteral Nutrition Tutorial | PPN vs CPN | PPN

[OkieSunRN]

Great thread. Thanks for the super helpful link.

[Brimurph2009]

Thank you so much for the link!

[heron, ASN, RN]

Trivia of the week: iv thiamine is yellow, thus the banana bag nickname. Typically given to alcoholics because of a presumed thiamine deficiency which can eventually lead to Wernicke-Korsakoff's Syndrome. You can smell the thiamine all the way down the hall. (My first rn job was at Boston City Hospital - acute medicine. I smelled banana bags and paraldehyde in my sleep!)

[IVRUS, BSN, RN]

Since there is very little Thiamine stored in the body, patients, especially CA patients may see deficiencies and supplemental Thiamine may be necessary. However, some suggest Folate (another component of a Banana Bag) may actually promote the progression of existing cancers or precancerous lesions and therfore this may have been a consideration by your hospitalist. SEE LINK:

Quantifying the Dose-Response Relationship Between Circulating Folate Concentrations and Colorectal Cancer in Cohort Studies: A Meta-Analysis Based on a Flexible Meta-Regression Model

As far as TPN vs PPN goes, TPN must ALWAYS infuse via one of the four different types of Central IV catheters. PPN on the other hand is an acronym for partial or peripheral parenteral infusion.

PPN may be given into a peripheral vein, but considerations must be assessed as to the final admixture of the solution. Usually anything above 600 on its osmolarity is too harsh to infuse into a vein in the arm. One does not have the blood flow in the arms as there is in the central venous system. Clinimix is a commonly given PPN formula.