Total parenteral nutrition

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    • Surgical nutrition
      • Nutritional assessment
        • Clinical assessment
          • Weight loss (MCQ)
            • 10%=mild malnutrition
            • 30%=severe malnutrition
          • Body mass index
        • Anthropometric assessment
          • Triceps skin fold thickness(MCQ)
          • Mid arm circumference
          • Hand grip strength
        • Blood indices
          • Reduced serum albumin, prealbumin or transferrin(MCQ)
          • Lymphocyte count
    • Enteral feeding
      • Prevents intestinal mucosal atrophy
      • Supports gut associated immunological shield
      • Attenuates hypermetabolic response to injury and surgery
      • Polymeric liquid diet
        • Short peptides ,Medium chain triglycerides and polysaccharides
        • Vitamins ,Trace elements
      • Elemental diet
        • L-amino acids ,Simple sugars
        • High osmolarity can cause diarrhea (MCQ)
        • Enteral feed can be taken orally or by NGT
      • Long term feeding can be by:
        • Surgical gastrostomy,jejunostomy
        • Percutaneous endoscopic gastrostomy
        • Needle catheter jejunostomy
      • Complications of enteral feeding
        • Malposition and blockage of tube
        • Gastrooesophageal reflux
        • Feed intolerance
      • Parenteral nutrition
        • Intestinal failure = ‘A reduction in functioning gut mass below the minimal necessary for adequate digestion and absorption of nutrients’
        • Can be given by either a peripheral or central line
      • Indications for Total Parenteral Nutrition
        • Absolute indications
          • Enterocutaneous fistulae (MCQ)
        • Relative indications (MCQ)
          • Moderate or severe malnutrition
          • Acute pancreatitis
          • Abdominal sepsis
          • Prolonged ileus
          • Major trauma and burns
          • Severe inflammatory bowel disease
      • Peripheral parenteral nutrition
        • Hyperosmotic solution
        • Significant problem with thrombophlebitis(MCQ)
        • Need to change cannulas every 24- 48 hours
        • No evidence to support it as a clinically important therapy
        • Composition – 12g nitrogen, 2000 Calories(MCQ)
      • Central parenteral nutrition
        • Hyperosmolar, low pH and irritant to vessel walls
        • Typical feed contains the following in 2.5L(MCQ)
        • 14g nitrogen as L-aminoacids
        • 250 g glucose
        • 500 ml 20% lipid emulsion
        • 100 mmol sodium ,100 mmol potassium ,150 mmol chloride
        • 15 mmol magnesium ,13 mmol calcium ,30 mmol phosphate
        • 0.4 mmol zinc ,Water and fat soluble vitamins  ,Trace elements
      • Complications of subclavian and jugular central venous lines
        • 10% of central lines develop significant complications
      • Problems of insertion
        • Failure to cannulate
        • Pneumothorax ,Haemothorax
        • Arterial puncture ,Brachial plexus injury
        • Mediastinal haematoma ,Thoracic duct injury
      • Metabolic complications of parenteral nutrition (MCQ)
        • Hyponatraemia
        • Hypokalaemia
        • Hyperchloraemia
        • Trace element and folate deficiency
        • Deranged LFTs
        • Linoleic acid deficiency


    Total Parenteral Nutrition 1
    How to Remove Home TPN(Nutrition) Post Gastric Bypass Surgery!
    his part comes after the actual infusion. I will do the actual setup this evening and post so everyone knows what I must do daily. Im on the TPN 16hrs and off 8 hrs every day. I hope this is educational to someone out there!
    PEG Feeding TubeThis 3D animation reveals the placement of a percutaneous endoscopic gastrostomy – PEG , or “feeding tube” in patients who are unable to take food by mouth for an extended period of time. It demonstrates the two main surgical techniques for PEG tube placement. 1. The “pull” method, 2. The “push” method. ANH00005
    Total Parenteral Nutrition
    Total Parenteral Nutrition 2
    How to prepare and administer TPN
    Parenteral Nutrition Writing
    TPN Administration by IV Team KKUH