Journal of Clinical Nutrition & Dietetics

Description

Patients with disorders requiring complete bowel rest, such as bowel obstruction, short bowel syndrome, gastroschisis, prolonged diarrhea regardless of its cause, very severe Crohn's disease or ulcerative colitis and certain pediatric GI disorders, such as congenital GI anomalies and necrotizing enterocolitis, may only be able to receive nutrition through transcutaneous nutrition. The geriatric population has physical, physiological, or mental differences that could cause them to consume fewer nutrients and necessitate nutrition therapy. Compared to younger patients, geriatric patients are more likely to experience delayed muscle restoration. Parenteral nutrition is the administration of nutrients through an intravenous route rather than through eating and digesting.

Administration of Nutrients through an Intravenous Route

Pharmaceutical compounding firms produce the goods. A formula-based nutritional mix containing glucose, salts, amino acids, lipids, vitamins and dietary minerals is given to the individual. When no significant nutrition is obtained through other means, it is referred to as Total Parenteral Nutrition (TPN) or Total Nutrient Admixture (TNA), whereas when nutrition is also partially enteric, it is referred to as Partial Parenteral Nutrition (PPN). When it is given through a vein access in a limb rather than a central vein like Central Venous Nutrition (CVN), it is called Peripheral Parenteral Nutrition (PPN). When the gastrointestinal tract is unable to function due to a disruption in its continuity (such as a blockage, leak, or fistula) or impairment in its absorptive capacity, Total Parenteral Nutrition (TPN) is administered. Although enteral feeding is typically preferred and less prone to complications, it has been used for comatose patients. In patients who are unable to obtain sufficient nutrients through oral or enteral methods, parenteral nutrition is used to prevent malnutrition. Waiting until the seventh day of hospital care is suggested by the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine (SCCM). Additionally, insulin resistance, vitamin and mineral deficiencies, and cardiac and renal impairment are seen to be more prevalent in older patients. Parenteral nutrition is a good option for people who need nutrition therapy but are allergic to or unable to eat through an enteral tube. When oral or enteral nutrition is likely insufficient for more than seven to ten days, it is indicated in the elderly population if oral or enteral nutrition is impossible for three days or more. Although there are no geriatric-specific complications of parenteral nutrition, increased comorbidities make complications more common in this population. When a person's digestive system has shut down (such as from peritonitis) and their weight is low enough to raise concerns about nutrition during an extended hospital stay, shortterm PN may be used. Patients who are dealing with the longterm effects of an accident, surgery, or digestive disorder may occasionally be treated with long-term PN. Children who were born with severely malformed or absent organs have lived longer thanks to PN. In the United States, approximately 40,000 individuals use TPN at home. Because TPN must be administered for 10-16 hours, daily life may be affected. The majority of patients agree that modifying one's daily routine is preferable to hospitalization. To shorten the amount of time a patient spends hooked up, there are many different kinds of pumps. For mobility, a backpack pump is typically used. Each patient's situation determines how long it takes to connect to the IV; some require five days a week or once daily. Patients must avoid as much lifestyle modification as possible related to TPN. This makes it possible to have the best mental health possible; resentment and depression can result from being held back constantly.

Conventional Methods of Nutrient Absorption

Patients must refrain from swimming (infection) and contact sports (damage to equipment), both of which are highly encouraged forms of physical activity. Due to issues with body image and being unable to participate in activities and events, many teens find living with TPN difficult. The GI tract and conventional methods of nutrient absorption are completely bypassed by TPN. The following is a list of possible complications that could be significant. Hypophosphatemia, hypokalemia, hyperglycemia, hypercapnia, decreased copper and zinc levels, elevated prothrombin time (if associated with liver injury), hyperchloremic metabolic acidosis, and decreased gastrointestinal motility are other common complications of TPN. The most common problem with TPN is an infection of the catheter, which is required for the solution to pass through. These patients frequently succumb to septic shock after an infection, which has a mortality rate of approximately 15% per infection. Compared to jugular and femoral vein insertions, the subclavian (or axillary) vein is preferred for central venous access due to its ease of access and lower infectious complications. Pneumothorax, accidental arterial puncture and catheter-related sepsis are all complications of the procedure. At the time of insertion, the complication rate should be less than 5%. By choosing the right catheter and using the right method to insert it, infections caused by catheters can be reduced. Blood clots frequently form on this IV line due to chronic IV access, which introduces a foreign object into the vascular system. Pulmonary embolism, in which a clot that begins on the IV line ruptures and travels to the lungs, preventing blood flow can cause death. Malnutrition and cachexia are more common in cancer patients, whether they are outpatients undergoing treatment or in the hospital. The altered metabolism, the increased need for energy, and the reduction in food intake are all factors that contribute to malnutrition in cancer patients. Any nutritional risk should be assessed early on by taking routine weight and BMI measurements on cancer patients. When the digestive tract cannot be reached or is ineffective, parenteral nutrition is recommended for cancer patients. If the approximate survival rate is greater than three months and PN is anticipated to significantly improve the patients' quality of life, the use of PN in advanced cancer patients should be discussed in terms of the risks and benefits. In patients with malignant bowel obstruction, it is unknown whether home parenteral nutrition improves survival or quality of life.