Saturday, September 20, 2014

Total Parenteral Nutrition (TPN): A Patient with 35 to 40 Kilograms of Body Weight

Follow the following points for total parenteral nutrition (TPN) or TPN feeding for a patient with weight of 35-40 kilograms:
  1. Pass CVP line (Use it only for parenteral feeding; don’t infuse other medicines through this line) 
  2. Injection 10% Dextrose Water (D/W) 1000ml + 2KCL + 1Multibionta (Round the clock = @ 11 drops/minute). Note: Monitor random blood sugar level thrice a day; if high- Add 10-12 units insulin R in 10% D/W; if low- Add 25% D/W ampoules in 10% D/W accordingly. Recommended dose of 10% D/W is 30-40ml/kg/day. 
  3. Injection B. Braun Aminoplasmal 10% (Round the clock = @ 6 drops/minute. Recommended dose is 10-20ml/kg/day. 
  4. Injection Lipofundin MCT/LCT 10% + 5000 units of Heparin (Round the clock = @ 6 drops/minute). Recommended dose is 10-20ml/kg/day. 
  5. Control complications! Catheter-related sepsis occurs in 50% of the patients while glucose abnormalities and liver dysfunction occur in > 90% of the patients.
  6. Monitoring: RBS thrice a day, Serum electrolytes daily, LFTs daily, Urea/Creatinine daily, Record input/output daily (monitor fluid overload or dehydration).
Keywords: Parenteral nutrition, Parenetral feeding, Central line, TPN feeding, CVP line, Dextrose water, Lipofundin, Aminoplasmal, Complications, Monitoring

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