Tpn

  1. Ok I got a question. I saw a order for a pt that started having problems swallowing and decrease appetite. They are using a bag specially made by pharm. I dont or can't remember the actual name for it. Some call it "Kool-Aid". It had Amino Acid, Ca+, K+ in it and so on.I do know the dr adjust it almost daily. Its also the color of urine. and then you hang a lipid drip with it. Anyways I over heard the family talking about it to the nurse. I guess my question is the same as the family. What are the benefits of this over say NG tube feeding ? If any. And whats so special about it? Is it better for the pt? or certain ones? Basically I don't understand. No one could really give me a in-depth answer on it. Thanks for any info you could give. Is this the only type of TPN?
    Last edit by Holly27 on Oct 2, '06
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    About Holly27

    Joined: Jun '06; Posts: 98; Likes: 7
    Cardiac Unit
    Specialty: Cardiac/Tele/Step-down

    12 Comments

  3. by   Antikigirl
    That is what I know to be TPN. Yellow liquid in a bag by pharmacy and MD and pharmacy work together dependant on labs and condition q 24 hours (or sometimes more frequently) to determine dose and of what. This is accompanied by the white lipid bottle. These are placed in a IV line.

    Are you thinking like a tube feeding? A bottle of brownish tan solution given via a feeding tube (NG or G or J tube)???

    Either way, sounds like the prescribing doc has some explaination to give the family over their choice and why. I would contact the MD and ask them to take some time and explain their choice so the family can understand...that is...given IF they have the RIGHT to know?
  4. by   Holly27
    Duh! Im such a nut! Ok let me redo my question then. What are the benefits if any over tube feedings? Why are they would they choose this over using maybe NG tube feeding?
  5. by   hospitalstaph
    Quote from Holly27
    Duh! Im such a nut! Ok let me redo my question then. What are the benefits if any over tube feedings? Why are they would they choose this over using maybe NG tube feeding?
    TPN or total parenteral nutrition goes into a central or PICC line directly into the tissues. An NG tube feeding goes into the GI tract. A person might be on TPN to let the GI tract "rest" after a GI bleed or UC/Crohn's flare.

    Hope this helps

    T
  6. by   Blee O'Myacin
    sinking an NG tube might cause unnecessary trauma and increase the risk of infection and bleeding. (Low platelet count, low white blood cell count).

    At our facility, the lipids come mixed in the bag. Do you have to run the lipids on a separate pump? Are they then infused together at a Y site?

    Blee
  7. by   Holly27
    No ours don't come together. We run them at the same time through a y site attached to the primary tubing. I guess cuz the tpn goes a primary tube and then has a filter line attached. The lipid has its own type line(its fatter) and its attach at the y site after the filter. and on to the CVL. It was my first time really dealing with it. I just always thought for some dumb reason that the words TPN and tube feeding meant the same thing. So now I know what "kool-aid" is! Yay for me. I learn something new everyday.
  8. by   meownsmile
    The benefits of giving TPN over tube feedings is basically all the nutrition in the TPN is delivered at a cellular level making it immediately available for the body to utlize rather than making the body breakdown and absorb nutrients from the GI tract. The doctor can control all the amino acids, lipids, vitamins, electrolytes, and fluids the patient gets making it easier for the doctor to control what the patient actually has to utilize for metabolizim. Those nutrients going through a tube feeding may not be absorbed and broken down and utilized preventing the patient from healing and regaining strength, and are not able to be controlled by the doctor. With a tube feeding the doctor is at the mercy of the manufacturer as to the nutrient mix, and the mercy of the patients own metabolism to be able to break down and absorb the nutrients into the digestive tract, then the body to be able to utilize what is broken down. Thats the best i can do right now, hope it helps some too.
  9. by   morte
    TPN is used when the GI tract...stomach,small and large intestine, are not functioning to maintain the nutritional needs of the patient....thru disease,such as crohns....or damage in some other way....hyperemesis gravidarum (sp)...is another example.....must have good documentation or ins will not pay....and it's VERY expensive...... the lipids are "Y"'d in below the filter because the lipid molecule is too big for the filter on the amino acid side.......always good to take advantage of seeing new stuff to learn!
  10. by   Holly27
    Quote from meownsmile
    The benefits of giving TPN over tube feedings is basically all the nutrition in the TPN is delivered at a cellular level making it immediately available for the body to utlize rather than making the body breakdown and absorb nutrients from the GI tract. The doctor can control all the amino acids, lipids, vitamins, electrolytes, and fluids the patient gets making it easier for the doctor to control what the patient actually has to utilize for metabolizim. Those nutrients going through a tube feeding may not be absorbed and broken down and utilized preventing the patient from healing and regaining strength, and are not able to be controlled by the doctor. With a tube feeding the doctor is at the mercy of the manufacturer as to the nutrient mix, and the mercy of the patients own metabolism to be able to break down and absorb the nutrients into the digestive tract, then the body to be able to utilize what is broken down. Thats the best i can do right now, hope it helps some too.
    Oh my gosh! You hit it right on the nail head! The family was asking how TPN was going to make pt stronger. They couldn't understand and I didn't really either. She is weak and TPN would surely help over the tube feeding. Thanks! Thats the type of info I need. I like to be able to explain things to pt and sometimes the medical books just don't cut it. Too much medical jargon. and then I have to come up with a easier way to explain things and I get myself and my pts even more confused. Thanks! Now I can tell my pt an easier understanding and maybe it will alleviate the fears of not understanding. Thanks!
  11. by   meownsmile
    Sure and also remember the patient has to expend energy to break down foods/nutrition through the GI tract. Getting it via the TPN conserves the much needed energy the patient needs to heal tissues and gain strength.
  12. by   nursepearl
    It could also be what we call a "banana bag" which is basically a bag of fluid with vitamins. Somtimes we hang it with lipids....depending on the pt.
    We use TPN a lot here on our oncology floor as out pts have a lot of nausea and of course can be pancytopenic, so you dont want to cause any unescessary trauma.
  13. by   rn undisclosed name
    I also had a patient who was being started on TPN yesterday because even though she can eat she was getting extremely nauseous (sp?). She had c. diff and everytime she had to go to the bathroom she would get nauseous and have dry heaves. She was also being treated with Phenergan and Zofran but she'd still get the nausea.

    Just thought I'd provide another example of why someone is getting TPN though I don't think I could explain it any better than meownsmile did.

    Kelly
  14. by   Tweety
    Good explanation by Meownsmile.

    The preferred way to provide nutrition is the natural way, i.e. through the GI tract. So if a person has dysphagia, or is not eating due to dementia, pysch issue, trauma, or whatever, it's best to feed with tube feeding. The GI tract can deteriorate without food.

    However, if a person is having extreme nausea or vomitting, absorption issues, obstruction,or as was mentioned thrombocytopenia which can cause bleeding, etc., or needed to have their electrolytes more tightly controlled (rare) then TPN is the choice.

    None really has an "advantage" over the other, but the patient's condition and assessment should be the guide as to which is advantageous for that particularly person.

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