Total parenteral nutrition: A boon to non-functional gastrointestinal patients

Akhlak Ahmed Khan; Anwar Khan; Mohsin Ali Khan; Devendra Kumar; Kamran Javed Naquvi

doi:10.1016/j.ipha.2023.10.007

Intelligent Pharmacy ›› 2024, Vol. 2 ›› Issue (2) : 263 -269. DOI: 10.1016/j.ipha.2023.10.007

Total parenteral nutrition: A boon to non-functional gastrointestinal patients

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Abstract

About 25 years ago it became apparent that TPN had value in the management of critically ill patients who were not being normally nourished because they either had gastrointestinal failure or could not tolerate the enteral preparations offered. Total parenteral nutrition (TPN) is a type of medication that provides nutrition to critically ill patients for whom enteral feeding is not possible. TPN is given through I.V route. Parenteral means outside of the digestive tract. TPN may be administered as peripheral parenteral nutrition (PPN) or via a central line, depending on the components and osmolality. TPN administered protein, fats, carbohydrates, vitamins and minerals. TPN plays a vital role in the growth and development of preterm neonates in NICU to provide micro nutrients, macro nutrients and electrolytes. TPN has extended the life of a small number of children born with non-existent or severely birth-deformed guts. Parenteral nutrition plays a major role in treating COVID-19 infection-related malnutrition in patients across the globe. Home parenteral nutrition (HPN) support has been an advancing therapy in the past 30 years. Patients who previously had no options to sustain their lives are now able to live at home, maintain employment, and continue with most daily activities. Although this therapy has been innovative and successful, it requires great financial and professional resources. Parenteral nutrition can be given for long periods of time. A large variety of complications can occur, related especially to the equipment or the nutrients. When the nutrition is given via a central venous catheter, then sepsis is a serious and possibly life-threatening complication. In case of administration via an arteriovenous shunt, thrombosis of the shunt is the most frequent problem.

Keywords

TPN / PPN / Malnourishment / PN / NICU / COVID-19

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Akhlak Ahmed Khan, Anwar Khan, Mohsin Ali Khan, Devendra Kumar, Kamran Javed Naquvi. Total parenteral nutrition: A boon to non-functional gastrointestinal patients. Intelligent Pharmacy, 2024, 2(2): 263-269 DOI:10.1016/j.ipha.2023.10.007

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References

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[1]	HamdanM, Puckett Y. Total parenteral nutrition. In: StatPearls [Internet]. Treasure Island (FL: StatPearls Publishing;2023 Jul 4, 2023 Jan. PMID:32644462.

[2]	BraunschweigC, LiangH, SheeanP. Indications for administration of parenteral nutrition in adults. Nutr Clin Pract. 2004 Jun;19(3):255–262. PMID:16215113.

[3]	MaudarKK. Total parenteral nutrition. Med J Armed Forces India. 1995 Apr;51(2):122–126. Epub 2017 Jun 26. PMID:28769264;PMCID: PMC5529889.

[4]	DuerksenDR, TingE, ThomsonP, et al. Is there a role for TPN in terminally ill patients with bowel obstruction? Nutrition. 2004 Sep;20(9):760–763. PMID:15325683.

[5]	FlemingCR, McGillDB, Hoffman 2ndHN, NelsonRA. Total parenteral nutrition. Mayo Clin Proc. 1976 Mar;51(3):187–199. PMID:815725.

[6]	TriantafillidisJK, Papalois AE. The role of total parenteral nutrition in inflammatory bowel disease: current aspects. Scand J Gastroenterol. 2014 Jan;49(1):3–14. PMID:24354966.

[7]	EkemaG, Milianti S, BoroniG. Total parenteral nutrition in patients with short bowel syndrome. Minerva Pediatr. 2009 Jun;61(3):283–291. PMID:19461572.

[8]	CulebrasJM, Martín-Peña G, García de Lorenzo A, Rodríguez-MontesJA. Nutrición periférica [Peripheral parenteral nutrition]. Rev Med Univ Navarra. 2006 Oct-Dec;50(4):26–29. Spanish. PMID:17424766.

[9]	BraunschweigC, LiangH, SheeanP. Indications for administration of parenteral nutrition in adults. Nutr Clin Pract. 2004 Jun;19(3):255–262. PMID:16215113.

[10]	SlatteryE, RumoreMM, DouglasJS, Seres DS. 3-in-1 vs 2-in-1 parenteral nutrition in adults: a review. Nutr Clin Pract. 2014 Oct;29(5):631–635. PMID:25606645.

[11]	MoriishiM, Kawanishi H. [Nutritional management in EN and TPN for dialysis patients]. Nihon Rinsho. 2004 Jun;62(Suppl 6):455–459. Japanese. PMID:15250346.

[12]	MohandasKM, Shastri YM, ShirodkarM. Total parenteral nutrition. Natl Med J India. 2003 Jan-Feb;16(1):29–33. PMID:12715955.

[13]	ZoranD. Nutritional management of gastrointestinal disease. Clin Tech Small Anim Pract. 2003 Nov;18(4):211–217. PMID:14738201;PMCID: PMC7129079.

[14]	RemillardRL, Thatcher CD. Parenteral nutritional support in the small animal patient. Vet Clin North Am Small Anim Pract. 1989 Nov;19(6):1287–1306. PMID:2512712.

[15]	McCarthyMC. Nutritional support in the critically ill surgical patient. Surg Clin North Am. 1991 Aug;71(4):831–841. PMID:1907407.

[16]	KaninM, YoungG. Incidence of thrombosis in children with tunneled central venous access devices versus peripherally inserted central catheters (PICCs). Thromb Res. 2013 Nov;132(5):527–530. Epub 2013 Aug 30. PMID:24055175.

[17]

RickardKA, FolandBB, DetamoreCM, et al. Effectiveness of central parenteral nutrition versus peripheral parenteral nutrition plus enteral nutrition in reversing protein-energy malnutrition in children with advanced neuroblastoma and Wilms’ tumor: a prospective randomized study. Am J Clin Nutr. 1983 Sep;38(3):445–456. PMID:6310983.

[18]	GorskiLA. TPN update: making each visit count. quiz 22 Home Healthc Nurse. 2001 Jan;19(1):15–21. PMID:11984914.

[19]	DavisJH. Total parenteral nutrition (TPN) at home: prototype high-tech home care nursing. Gastroenterol Nurs. 1996 Nov-Dec;19(6):207–209. PMID:9025400.

[20]	FishJ, Steiger E, SeidnerDL. Recent developments in home total parenteral nutrition. Curr Gastroenterol Rep. 2000 Aug;2(4):327–330. PMID:10981032.

[21]	RollinsCJ, Elsberry VA, PollackKA, PollackPF, Udall Jr JN. Three-in-one parenteral nutrition: a safe and economical method of nutritional support for infants. JPEN J Parenter Enteral Nutr. 1990 May-Jun;14(3):290–294. PMID:2112645.

[22]	LowrySF, Goodgame Jr JT, MaherMM, BrennanMF. Parenteral vitamin requirements during intravenous feeding. Am J Clin Nutr. 1978 Dec;31(12):2149–2158. PMID:103422.

[23]

AdolphM, HellerAR, KochT, et al. Working group for developing the guidelines for parenteral nutrition of the German association for nutritional medicine. Lipid emulsions -guidelines on parenteral nutrition, chapter 6. Ger Med Sci. 2009 Nov 18;7:DoC22. https://doi.org/10.3205/000081. PMID:20049078;PMCID: PMC2795378.

[24]	GreenlawCW, GeigerGS, Haug 3rdMT. TPN formulations. Am J Hosp Pharm. 1979 Jan;36(1):28–29. PMID:103432.

[25]	LavalleeCM, MacPherson JAR, ZhouM, et al. Lipid emulsion formulation of parenteral nutrition affects intestinal microbiota and host responses in neonatal piglets. JPEN J Parenter Enteral Nutr. 2017 Nov;41(8):1301–1309. Epub 2016 Aug 5. PMID:27495286.

[26]	StawnyM, Olijarczyk R, JaroszkiewiczE, Jeli nskaA. Pharmaceutical point of view on parenteral nutrition. Sci World J. 2013 Dec 22;2013:415310. https://doi.org/10.1155/2013/415310. PMID:24453847;PMCID: PMC3885274.

[27]	IaconeR, Scanzano C, SantarpiaL, CioffiI, Contaldo F, PasanisiF. Macronutrients in parenteral nutrition: amino acids. Nutrients. 2020 Mar 14;12(3):772. PMID:32183395;PMCID: PMC7146427.

[28]	ChowdaryKV, ReddyPN. Parenteral nutrition: revisited. Indian J Anaesth. 2010 Mar;54(2):95–103. PMID:20661345;PMCID: PMC2900762.

[29]	SmithLC, MullenJL. Nutritional assessment and indications for nutritional support. Surg Clin North Am. 1991 Jun;71(3):449–457. PMID:1904636.

[30]	PironiL, ArendsJ, BozzettiF, et al. Home artificial nutrition & chronic intestinal failure special interest group of ESPEN. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr. 2016 Apr;35(2):247–307. Epub 2016 Feb 8. Erratum in: Clin Nutr. 2017 Apr;36(2):619. PMID:26944585.

[31]	ChowdaryKV, ReddyPN. Parenteral nutrition: revisited. Indian J Anaesth. 2010 Mar;54(2):95–103. PMID:20661345;PMCID: PMC2900762.

[32]	MaudarKK. Total parenteral nutrition. Med J Armed Forces India. 1995 Apr;51(2):122–126. Epub 2017 Jun 26. PMID:28769264;PMCID: PMC5529889.

[33]	KornbauC, LeeKC, HughesGD, Firstenberg MS. Central line complications. Int J Crit Illn Inj Sci. 2015 Jul-Sep;5(3):170–178. PMID:26557487;PMCID: PMC4613416.

[34]	ChowdaryKV, ReddyPN. Parenteral nutrition: revisited. Indian J Anaesth. 2010 Mar;54(2):95–103. PMID:20661345;PMCID: PMC2900762.

[35]	SteginkLD, Freeman JB, WispeJ, ConnorWE. Absence of the biochemical symptoms of essential fatty acid deficiency in surgical patients undergoing protein-sparing therapy. Am J Clin Nutr. 1977 Mar;30(3):388–393. PMID:402809.

[36]	AlchaerM, Khasawneh R, HeubergerR, HewlingsS. Prevalence and risk factors of total parenteral nutrition induced hyperglycemia at a single institution: retrospective study. Metab Syndr Relat Disord. 2020 Jun;18(5):267–273. Epub 2020 Apr 6. PMID:32250718;PMCID: PMC7437573.

[37]	GutcherG, CutzE. Complications of parenteral nutrition. Semin Perinatol. 1986 Jul;10(3):196–207. PMID:3103220.

[38]	MaudarKK. Total parenteral nutrition. Med J Armed Forces India. 1995 Apr;51(2):122–126. Epub 2017 Jun 26. PMID:28769264;PMCID: PMC5529889.

[39]	HeymsfieldSB, BethelRA, AnsleyJD, Nixon DW, RudmanD. Enteral hyperalimentation: an alternative to central venous hyperalimentation. Ann Intern Med. 1979 Jan;90(1):63–71. PMID:105658.

[40]	KleinS, SimesJ, BlackburnGL. Total parenteral nutrition and cancer clinical trials. Cancer. 1986 Sep 15;58(6):1378–1386. PMID:3091243.

[41]	HamdanM, Puckett Y. Total parenteral nutrition. In: StatPearls [Internet]. Treasure Island (FL). StatPearls Publishing;2023 Jul 4, 2023 Jan-. PMID:32644462.

[42]	WaitzbergDL, Plopper C, TerraRM. Postoperative total parenteral nutrition. World J Surg. 1999 Jun;23(6):560–564. PMID:10227924.

[43]	HeberleinW. Principles of tunneled cuffed catheter placement. Tech Vasc Interv Radiol. 2011 Dec;14(4):192–197. PMID:22099010.

[44]	BraswellLE. Peripherally inserted central catheter placement in infants and children. Tech Vasc Interv Radiol. 2011 Dec;14(4):204–211. PMID:22099012.

[45]	YuanCM, Oliver 3rd JD, LittleDJ, et al. (for the Nephrology Education Research and Development Consortium—NERDC). Survey of non-tunneled temporary hemodialysis catheter clinical practice and training. J Vasc Access. 2019 Sep;20(5):507–515. Epub 2018 Dec 28. PMID:30590997.

[46]	ChungHY, Beheshti MV. Principles of non-tunneled central venous access. Tech Vasc Interv Radiol. 2011 Dec;14(4):186–191. PMID:22099009.

[47]	MuellerC, Compher C, EllenDM. American society for parenteral and enteral nutrition (A.S.P.E.N.) board of directors. A.S.P.E.N. clinical guidelines: nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr. 2011 Jan;35(1):16–24. PMID:21224430.

[48]	KirbyDF. Improving outcomes with parenteral nutrition. Gastroenterol Hepatol. 2012 Jan;8(1):39–41. PMID:22347831;PMCID: PMC3277197.

[49]	ChowdaryKV, ReddyPN. Parenteral nutrition: revisited. Indian J Anaesth. 2010 Mar;54(2):95–103. PMID:20661345;PMCID: PMC2900762.

[50]	LeibAD, England BS, KielJ. Central line. In: StatPearls [Internet]. Treasure Island (FL: StatPearls Publishing;2023 Jul 24, 2023 Jan-. PMID:30137796.

[51]	FesslerAG, RejratCE. Re-Evaluating safe osmolarity for peripheral parenteral nutrition in neonatal intensive care patients. J Pediatr Pharmacol Ther. 2021;26(6):632–637. Epub 2021 Aug 16. PMID:34421414;PMCID: PMC8372860.

[52]	DriscollDF, Bistrian BR. Special considerations required for the formulation and administration of total parenteral nutrition therapy in the elderly patient. Drugs Aging. 1992 Sep-Oct;2(5):395–405. PMID:1392222.

[53]	AmeriZD, VafaeeA, SadeghiT, Mirlashari Z, Ghoddoosi-NejadD, KalhorF. Effect of a comprehensive total parenteral nutrition training program on knowledge and practice of nurses in NICU. Glob J Health Sci. 2016 Oct 1;8(10):56478. PMID:27302458.

[54]	PearsonML. Guideline for prevention of intravascular device-related infections. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol. 1996 Jul;17(7):438–473. PMID:8839803.

[55]	PatelP, BhatiaJ. Total parenteral nutrition for the very low birth weight infant. Semin Fetal Neonatal Med. 2017 Feb;22(1):2–7. Epub 2016 Aug 27. Erratum in: Semin Fetal Neonatal Med. 2018 Feb;23 (1):75. PMID:27576106.

[56]	MoysesHE, Johnson MJ, LeafAA, CorneliusVR. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J Clin Nutr. 2013 Apr;97(4):816–826. Epub 2013 Feb 27. PMID:23446896.

[57]	ChanAP, RostasS, RogersS, Martin CR, CalkinsKL. Parenteral nutrition in the neonatal intensive care unit: intravenous lipid emulsions. Clin Perinatol. 2023 Sep;50(3):575–589. Epub 2023 Jun 1. PMID:37536765.

[58]	RayS. NICE guideline review: neonatal parenteral nutrition (NG154). Arch Dis Child Educ Pract Ed. 2021 Oct;106(5):292–295. Epub 2020 Nov 16. PMID:33199498.

[59]	PrathikBH, Aradhya AS, SahooT, SainiSS. Neonatal total parenteral nutrition: clinical implications from recent NICE guidelines. Indian Pediatr. 2021 Jan 15;58(1):67–70. PMID:33452777.

[60]	Quinby JrGE, NowakMM, AndrewsBF. Parenteral nutrition in the neonate. Clin Perinatol. 1975 Mar;2(1):59–81. PMID:810293.

[61]	GrotteG, Esscher T, HambraeusL, MeurlingS. Nutrition parentérale complète dans la chirurgie infantile [Total parenteral nutrition in pediatric surgery]. Ann Anesthesiol Fr. 1974;15(2 Spec No):65–73. French. PMID:4220205.

[62]	Parenteral Nutrition Global Market Report ID -6317617. Publisher-The business research company; March 2023.

[63]	HuangC, WangY, LiX, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497–506. Epub 2020 Jan 24. Erratum in: Lancet. 2020 Jan 30;PMID:31986264;PMCID: PMC7159299.

[64]	BarazzoniR, Bischoff SC, BredaJ, et al. Endorsed by the ESPEN Council. ESPEN expert statements and practical guidance for the nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr. 2020 Jun;39(6):1631–1638. Epub 2020 Mar 31. PMID:32305181;PMCID: PMC7138149.

[65]

BoullataJI, Gilbert K, SacksG, et al. American Society for Parenteral and Enteral Nutrition. A.S.P.E.N. clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling, and dispensing. JPEN J Parenter Enteral Nutr. 2014 Mar-Apr;38(3):334–377. Epub 2014 Feb 14. PMID:24531708.

[66]	BoullataJI, Berlana D, PietkaM, KlekS, Martindale R. Use of intravenous lipid emulsions with parenteral nutrition: practical handling aspects. JPEN J Parenter Enteral Nutr. 2020 Feb;44(Suppl 1):S74–S81. PMID:32049398.

[67]	Van den BergheG, Wouters P, WeekersF, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001 Nov 8;345(19):1359–1367. PMID:11794168.

[68]	SingerP, BlaserAR, BergerMM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019 Feb;38(1):48–79. Epub 2018 Sep 29. PMID:30348463.

[69]	HuangC, WangY, LiX, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497–506. Epub 2020 Jan 24. Erratum in: Lancet. 2020 Jan 30;: PMID:31986264;PMCID: PMC7159299.

[70]	Van GossumA, CabreE, HébuterneX, et al, ESPEN. ESPEN guidelines on parenteral nutrition: gastroenterology. Clin Nutr. 2009 Aug;28(4):415–427. Epub 2009 Jun 9. PMID:19515465.

[71]	MenéndezJJ, Verdú C, CalderónB, et al. Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children. J Thromb Haemost. 2016 Nov;14(11):2158–2168. Epub 2016 Oct 12. PMID:27558946.