Total Parental Nutrition

Total parenteral nutrition or TPN is perhaps one of the most exciting technique$ that has come a-long in the last few years. TPN can be defined as the delivery of sufficient nutrition via the intra venous route to maintain an ana­bolic state in a patient without any oral intake over an extended period of time.  The limit'ation of fulfatling the patient's nutri­tional requiremetlt by 5% or 10% de;;xtr·ose water, which is commonly used for short periods of time is discussed. The possibility of using various nutrients to correct this limitation alcng with principals of hyperalimentation has been taken into consideration.  Various solutions are userl for TPN. Basic­ally they aiil contain an amino acid solution and 50% dextrose in water to which electrolyte and multi vitamins are added. The final solution contains 20% glucose and 3% amino acid which is extremely hyperosmolar. Therefore the tech­nique for putting a catheter directly into the heart W'as developed to give maximum dilution. A thin waiHed radiopaque SJilastic catheter is used to deliver the hyperalimentation solution. T·he solutions have to be infused slowly and at a constant rate. During the process of h·· peralimentation patients must be monitoreil very dos·ely for different parameters which has been discussed.  'Ihere are· numerous indications for TPN but · especially three groups of patients can be select­ed for TPN: surgical patients with gut anoma­lies, those with reversible G.I. lesions secondary to surgical complications and })atients with chronic intractable di1arrhea. Recently there is greait interest in feeding premature babies witb hyperalimentation. The complications of this technique are many and of great importance; apart from the ones related to the pl.a.cement of the catheter, the mos serious catheter related complication is sepsis. By taking various preeautions regard­ing controlling infection the incidence has been dropped from 40% to 9%. The metabolic pro­blems, i.e. hyper and hypogylcemia, acidosis, etc. have been covered. This technique can best be applied with very exciting results in the large, well equipped medi­ca centers, where it is possible to have patients under very close observation.