Does TPN prolong life?

Have you tried to research this yourself first? It would be better for you to find your own articles and do your own research first, then ask if you need additional clarification. I'm not saying this to be unkind, but a lot of students post these types of questions without ever doing their own legwork.

Part of being a student is learning how to do research. This topic has been heavily researched, so it should be relatively easy for you to find articles about it.

I have tried researching this through EBSCO and Cinahl, and unfortunately, have not gotten any hits on articles that allow access to the full material. I found the same to be true in PUBMED. Perhaps I searched poorly, but yes, to answer your question, I have given it a try.

Well, a simple Google search pulled up tons of articles from hospice organizations and other medical sources. Maybe you can start there.

Be glad you didn't go to school in the "bad old days" like I did when there was no such thing as the internet, and you had to (gasp!) go to a library! :chuckle

With all due respect I'm writing from a library. Your tone is quite confrontational. I solicited articles in that I thought if someone had a reference, it would be polite for me to read the reference rather than ask the person to write a paper for me. That's all. As I understand this forum, no one is forcing you to respond to my or anyone else's attempt at conversation. I chose not to google it, because I'd prefer peer-reviewed medical research. I hope your day improves.

Had a situation that I've heard about - I was not involved in it and only know hearsay. A patient was prescribed TPN. A nurse went and spoke with the family, including the patient's power of attorney before the TPN was started and before the doctors involved had a chance to explain thier reasoning. The patient was NPO. The patient was non-responsive. The nurse opposed TPN, feeling the patient was dying and this would prolong suffering. The TPN was ordered on Saturday, the patient passed several days later. The family, based on the nurse's explanation declined the TPN. My question is, was the patient starved? Resource articles would be appreciated. Thanks.

It depends on a lot of factors. TPN can provide hydration for someone dying but sometimes dehydration isn't a bad thing in someone dying and suffering, such as a terminal cancer patient. It can potentially extend life. But in what cases is life to be forced to endure? If the body is dying and nothing is going to change that, is buying the patient a few more days of suffering a good thing?

I don't think you have provided enough information about this patient to give a good answer.

Will someone starve to death without a few days of nutrition? What do you think? I'm not trying to be snitty here but instead I am asking you. Do you think holding food (not water, just food) from someone for a few days will kill them?

Unfortunately, I've shared all the information I have. You've offered me some questions to think about. Thank you for your comments.

I am answering from a hospice perspecitve. TPN is not an aproved hospice treatment because it does not promote comfort TPN can indeed prolong life. Forced nutrition i.e. forced feeding, tube feeding and other forms of artificial feeding are counter to end of life comfort because at the end of life the body is shutting down and not able to process these. Even IV hydration is counter productive to comfort as the kidneys are less efficient, you often have third spacing and the increased fluid in the tissues makes breathing uncomfortable. Again the body is not able to handle IV fluids as it is dying the way a healthy viable body does.

I am sorry I do not have specific research to referr you to at hand. Perhaps you can find it by doing a palliative care and or hospice care search.

Thanks to all for your posts, these have been helpful.

What an interesting situation! My first thought was why didn't the doctors talk to the family first and let them know what they were planning for the patient's treatment before even writing the TPN order.

Unfortunately I have learned as have many of you the hard way that physicians are not educated in end of life care and more importantly they are not educated in talking to patients and families about end of life.

Our medical mindset is to save lives. It is not to respect the fact that everyone will die inspite of any medical intervention. It is not to respect the fact that our interventions can and often are harmful to a person's spirit, dignity and even the physical body which we are attempting to fix.

Nurses on the other hand have more of a humanistic aproach. THat is not to say even our so called hollistic view is more times then not tainted by the medical view point.

We are taught to talk to patients and families or at least learn much earlier then physicians about these things.

What is more the OP mentioned this was in an ER. It is my experience that the ER Doctor is usually a young doctor more times than not one who has never had a practice out side the hospital. One who has little experience with actually having to spend time with patients and families actually talking. They know least how to talk to a person about such things. They know least about options available. Options like palliative care, hospice etc.

I had a difficult time convincing a 40 year old physician that we had not one but 4 hospices in our area ready to serve a patient that clearly needed their services. Further more these docs do not know what hospice and palliative care really is. They have very superficial knowledge.

Some doctors never seem to learn how to talk to people when it really matters. That is why we step in and say the really hard words to the family and patient. That is why we know when a family really needs to hear that stuff and the doc's are scared until we have cleared the path for them.

That is why doc's routienly second guess wishes and declaire that, THe patient or family would never go for a no code status or never go for a comfort care etc. They second guess because they are scared out of thier witts. They are scared that if they suggest they can do no more and the patient is going to die that a great catostrophy will befall the doctor if he speaks the truth. That catostrophy bieng in the form of people getting angry with him.

The doc's do not understand that it is not about the doc. They truly have been brainwashed into believeing that they are expected to perform the impossible miracle.

When a patient experience a good death it is usually because a nurse not a physician made it happen. Doctors who terminally wean patients off ventilators (who have a lot of experience with terminal weans) do not stick around once the order is written. Even when a family requests the doc's presences they are "much too busy". They say as little as they can and take off. They let the nurses carry the bag. These are experienced docs. They never learned to be human and they never learned it is ok to show they are human.