Does TPN prolong life?

sjrn85 · Nov 21, 2005

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.

Nursing1Student · Nov 21, 2005

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.

sjrn85 · Nov 21, 2005

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

Nursing1Student · Nov 21, 2005

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.

Bipley · Nov 21, 2005

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?

Nursing1Student · Nov 21, 2005

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

P_RN, ADN, RN · Nov 21, 2005

If you have a disagreement with another poster, the forum is NOT the place toair it. Use of words such as confrontational, bitter , naysayers and such is not productive.

Thread is closed for the time being and will be discussed among the staff.

______

Reopened. Please remember to report rather than RETORT when there is a problem with another post or poster. Thanks.

Agnus · Nov 21, 2005

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.

suzanne4, RN · Nov 21, 2005

TPN is considered nutrition, not hydration, in most books. That may answer your questions easily. It is hard on the liver to break down all of the components. That is why TPN should only be used when there is an issue with the GI tract, otherwise tube feedings are the best way to feed someone, if they are unable to take a regualr diet.

Nursing1Student · Nov 21, 2005

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

Daytonite, BSN, RN · Nov 21, 2005

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 orders? TPN is more of a maintenance thing, not an acute life-saving one. A non-responsive NPO patient can be sustained on IV fluids with electrolytes and minimal glucose for some days while a more permanent solution is discussed (i.e. tube feeding, TPN). It sounds like the docs were grabbing at straws as the patient was circling the drain. If it had been really necessary I'm sure the doctors would have convinced the family that TPN was needed despite what the nurse may have told them. I've worked many years and seen many, many patients in vegetative states maintained for months on TPN. The only reason for doing TPN is usually because the patient for some reason can't tolerate gastric feedings. I saw doctors time and again use TPN as a last resort to keep patients alive in a hopeless situation. This sounds, as well, as a case of trying to do everything medically available to attempt to sustain a patient's life. If anything has been learned over all these years, it's that some situations are hopeless. I think that perhaps the nurse you talk about recognized this. What red flags me about this situation is that the docs would order something like TPN without discussing it at length with the family first since it is a serious undertaking that carries a number of risks to the patient.