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Crohn's Disease Forum » Treatment » Enteral Nutrition & TPN » Total parenteral nutrition (TPN)


11-05-2009, 08:15 PM   #1
Skinny Dub
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total parenteral nutrition (TPN)

Not sure where to post this but this forum seems to get the most traffic. I have tried the search function and didn't really come up with much on the topic, so lets start one.

For me personally my self and family and now my doctors would like to get me on TPN. The main concern for us is an infection before surgery and having to delay that.

Reasons
1. cant eat anymore then one or two small meals a day (still get pain).
2. have lost more then 20lbs in a few months.
3. my weight is down to 115lbs I'm 5'8" 24 year old male
4. malnourished do to the fact I cant eat.
5: Want to get everything boosted up before surgery next month.

Insurance is a whole other game I have to try and play, to get them to cover it as of now it looks like I need to go threw the ER to try and receive it. Hopefuly cover me if I am at home with it aswell but that might be long shot.

Please share your thoughts experience and or anyone Else's that has been on TPN.
11-05-2009, 08:26 PM   #2
imisspopcorn
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From personal experience, I have only been on it once. It was last year right before my resection. I was on it for about 5 days and then discharged. You will need some sort of central line ie...PICC line. The PICC insertion is a piece of cake IMO. TPN can be very hard on your kidneys so you probably will be seen by a nephrologist. Also, the concentration of glucose is a great source of energy for pesky bacteria, so you have an increased risk of infection. Since it is given via a central catheter, you really don't want an infection in that area.

You need protein to heal after any sort of surgery, it probably will help you in the long term. Relatively speaking, the risks associated with Tpn are minimal if monitored.
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11-05-2009, 09:29 PM   #3
Skinny Dub
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Quoted from wikipedia

Parenteral nutrition is provided when the gastrointestinal tract is nonfunctional because of an interruption in its continuity or because its absorptive capacity is impaired (Kozier et al., 2004). It has been used for comatose patients, although enteral feeding is usually preferable, and less prone to complications. Indications: TPN may be the only feasible option for patients who do not have a functioning GI tract or who have disorders requiring complete bowel rest, such as the following: Some stages of Crohn's disease or ulcerative colitis, bowel obstruction, certain pediatric GI disorders, e.g., congenital GI anomalies, prolonged diarrhea regardless of its cause, or short bowel syndrome due to surgery (The Merck Manual, 2008).

Short-term PN may be used if a person's digestive system has shut down (for instance by peritonitis), and they are at a low enough weight to cause concerns about nutrition during an extended hospital stay. Long-term PN is occasionally used to treat people suffering the extended consequences of an accident, surgery, or digestive disorder. PN has extended the life of children born with nonexistent or severely deformed organs. People have survived on total parenteral nutrition for more than 35 years, living fully productive lives.

The preferred method of delivering PN is with a medical infusion pump. A sterile bag of nutrient solution, between 500 mL and 4 L, is provided. The pump infuses a small amount (0.1 to 10 mL/hr) continuously in order to keep the vein open. Feeding schedules vary, but one common regimen ramps up the nutrition over one hour, levels off the rate for a few hours, and then ramps it down over a final hour, in order to simulate a normal metabolic response resembling meal time. This should be done over 12 to 24 hours rather than intermittently during the day.

Chronic PN is performed through a central intravenous catheter, usually through the subclavian or jugular vein with the tip of the catheter at the superior vena cava without entering the right atrium. Another common practice is to use a PICC line, which originates in the arm, and extends to one of the central veins, such as the subclavian with the tip in the superior vena cava. In infants, sometimes the umbilical vein is used.

Battery-powered ambulatory infusion pumps can be used with chronic PN patients. Usually the pump and a small (100 ml) bag of nutrient (to keep the vein open) are carried in a small bag around the waist or on the shoulder. Outpatient TPN practices are still being refined but have been used for years. Patients can receive the majority of their infusions while they sleep and instill heparin in their catheters when they are done to simulate a more "normal" life style off the pump.

Aside from their dependence on a pump, chronic PN patients can live quite normal lives. A non-profit organization, the Oley Foundation, provides free information and programs to better the quality of life for PN and tube fed patients.

In most US hospitals, clinical pharmacists evaluate the patient's individual data and decide what PN formula to use.
The most common complication of PN use is bacterial infection, usually due to the increased infection risk from having an indwelling central venous catheter. In patients with frequent bacterial infections, fungal infections can also occur. Liver failure, often related to fatty liver, may sometimes occur. This condition is generally due to excess in glucose provided in PN solutions.

A recent small-scale study at Children's Hospital Boston on the cause of liver failure suggests it may be due to a large difference in omega-6 to omega-3 ratio. When treated with Omegaven, a different fatty acid infusion (which is approved for limited use in the U.S.), two patients were able to recover from their condition.[1]

Two related complications of PN are venous thrombosis and rarely priapism. Fat infusion during PN is assumed to contribute to both.[2]

Total parenteral nutrition increases the risk of acute cholecystitis due to complete unusage of gastrointestinal tract, which may result in bile stasis in the gallbladder.

11-13-2010, 09:34 AM   #4
krouf1157
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1. TPN is a medically acceptable way to have proper nutrition without the typical means of eating.
2. Using an IV, an IV bag is created especially for you to meet your specific needs.
3. Your heath care team of doctors, dietitians and pharmacists will assist you.
4. It is important especially if you start out in a compomised health status to be sure to have sterile techniques to avoid any infections.
11-14-2010, 06:20 PM   #5
Sailorluna
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I was in the hospital for a resection surgery in June. I was there for 14 days and had a PICC line with TPN the whole time. It was the same idea - I was malnourished and my protein was so low that they thought surgery would be dangerous. The TPN looks kind of like a giant bag of Mountain Dew. The PICC line was not really a big deal and once they got it in it was a great thing because they could take blood samples out of it without jabbing me anew everytime. I think it had two ports one for the regular saline and one for the TPN. The most annoying part of it was showering because they would not remove it and would wrap the arm in plastic also they would leave the machine attached and sitting right outside the shower. Oh yes - and sleeping with lines attached to you. Being attached to a machine for days on end sucks. Even with wheels.

At the end of the two weeks the area around the picc line was red and swollen but it must not have been infected because they just had me keeping ice on it. They keep a close eye on the picc line for infection though - I think the "special" nurses that did the picc line checked on it every day.

At one point they offered to let me bring it home for the weekend but I have two little kids and was too nervous to have it at home around them. I am unsure if it is different set up for home use.

Are you expecting to have the TPN for a full month prior to surgery? Have they told you if you will be allowed to eat at all?

After about two days on the TPN my energy level was really increased and at the end of the two weeks it was off the charts. I think you will be surprised. Good luck with your surgery.
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Symptoms since 98
Resection and diagnosis June 2010
3 fistulas
abscess drained 6 times (so far...)
currently 2 seton in place 1 since 9/11 the other 4/14
1 strange small air pocket with an 8 cm sinus track leading into the great unknown
methotrexate weekly
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11-15-2010, 05:20 AM   #6
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I am 5 weeks post op and had tpn for 7 days prior and 14 days after. I was advised I had to be in hospital for the whole time as they need to keep a close eye on electrolytes, blood sugar etc. I put on 2 kg in the week prior to surgery was allowed to eat whatever I wanted while on it prior to op. My biggest concern was infection but as long as nurses use proper hygiene procedure whenever changing dressing etc It seemed to be able to be avoided. I had no choice as I had low protien, iron, etc. It' annoying having what I called my "drippy mate" by my side 24 hrs. When they are inserting the PICC line make sure they insert further enough away from the elbow crease so you can bend your arm. I was unable to bend my left arm the whole time.
All the Best
Good Luck
11-15-2010, 11:48 AM   #7
Crohnadian
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I just got discharged from a 5 week stay which was when I had my surgery. I was on a clear liquid diet for 4 weeks, and here and there they would tell me POD which is nothing (not even water) by mouth for a couple of days. It was difficult, but the TPN gave my body what it needed so I didn't starve. The picc line was pretty easy to insert and taking it out was even easier (bedside pull and patch). TPN is really great, I owe my life to it. They were giving me insulin shots while I was on it and monitoring my blood glucose because it's a constant inflow of sugars. I got an extra week's worth of the TPN because my surgery had been delayed a week too. Lipids were given to me as well (20% fat, smells bad too lol)...
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Updated 11/15/2010
03-17-2011, 12:28 PM   #8
hopeful
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Anyone had side effects from TPN like increased diarrhea (even without eating) or stomach contractions?
12-04-2011, 03:21 PM   #9
makey
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ive been on tpn for 11 months now. its is feed through a hickman line i have in my chest, when in hospital you get taught how to connect and disconnect to prevent infection. i am on it 3 days a week for 12.5 hours pre night. if you need any more info just ask
01-08-2012, 01:55 PM   #10
ahng
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I was on TPN while and after I was pregnant with my daughter. I never ate and I was losing a lot of blood as well as immense amounts of pain. I was really worried about losing my daughter and I didn't know I was pregnant for at least 3 months. I was passing out from the sugar problem with prednisone and being pregnant too. It was a really terrible experience. I enjoyed not eating though, or eating what I wanted that I could eat without having to worry if I didn't eat enough or losing weight. I ended up getting a serious infection, sepsis, with it however and I was pretty sick after giving birth due to a breast infection where my skin was wiping off. I gave birth via an emergency c-section where my daughter was a month early because my water broke. I am happy that I had it but it also was terrible afterward. I didn't eat very much and food didn't taste like anything so when I was off of it I continued to lose weight and I refused to take any steriods because they made me nuts. I was a loony toon. I have a lot of experience with it however and I am glad I had it but boy..
I am surprised I am alive.
03-15-2012, 04:41 PM   #11
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I just started tpn on Tuesday, and it's comforting to know that I'm getting all of my nutrition. I'm on it for bowel rest in hopes that it will stabilize me until I can get more stem cell infusions through a trial I'm currently in. I don't really have much of an appetite, so not eating isn't the biggest problem in the world. Weird thing though is that I haven't eaten anything since Sunday and I'm still having bowel movements with blood. And when I have them, I get incredibly nauseous and throw up [which is odd for me, because I don't throw up usually].
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Diagnosed with Crohn's: January 2008
Surgeries: Gastrostomy [March 2011, Reversal September 2011], Pic Line Insertion [Multiple, most recent: March 2011, Reversal April 2012], Iliestomy [May 2013]
Failed Meds: 6mp, Remicade, Humira, Methotrexate, Flagyl, Thalomid, Cimzia, Elemental Diet, Probiotics, SCD Diet, Pentasa, Prednisone, and Entocort
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08-18-2012, 06:59 AM   #12
Avw
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I just started tpn on Tuesday, and it's comforting to know that I'm getting all of my nutrition. I'm on it for bowel rest in hopes that it will stabilize me until I can get more stem cell infusions through a trial I'm currently in. I don't really have much of an appetite, so not eating isn't the biggest problem in the world. Weird thing though is that I haven't eaten anything since Sunday and I'm still having bowel movements with blood. And when I have them, I get incredibly nauseous and throw up [which is odd for me, because I don't throw up usually].
I'm having similar issues, though I just started back on my TPN a few days ago. I was able to eat some while hospitalized last week b/c the pain meds made going tolerable and slowed down my bm's. I've also noticed that when on the TPN, I wake up in the night constantly, absolutely parched! More so than before I was on it, and knew I was dehydrated. Anyone else experience this?

I also wanted to ask if you are still taking any medications by mouth? I am, and have to eat a few bites of crackers or bread so the meds don't rip my stomach to shreds... so maybe try eating a few saltines or something you tolerate well, just to help with all that gastric acid. I'm by no means a medical professional... but these are just things that have helped me.
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Previous Medications:
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Insurance still rejecting appeals for Stem Cell Transplant. Tested positive for JCV Antibody so Tysabri is not an option. Searching for matches in Cord Blood Registry and working with an attorney to fight insurance company. Fingers and toes crossed!
08-18-2012, 07:19 AM   #13
Avw
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Anyone had side effects from TPN like increased diarrhea (even without eating) or stomach contractions?
I'm starting to wonder if I am having some of these... I do still eat a little just to settle my stomach, but just Saltines or bread, and have yet to see any of this "bowel rest" the TPN is supposed to provide. I am wondering if it has anything to do with the fat or sugar content in the mixture? I don't tolerate fatty foods whatsoever, hence the reason I don't eat most meat. I don't know if fats in liquid nutrition can have the same effect as fats in food... but that may be a part of it. Who knows...
08-18-2012, 10:18 AM   #14
ravensfan88
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I've also noticed that when on the TPN, I wake up in the night constantly, absolutely parched! More so than before I was on it, and knew I was dehydrated. Anyone else experience this?
I have this problem. I wake up in the middle of the night 5+ times and have to empty my bladder. I also bring 3 Bottles of water to bed with me and almost drink all 3 of them throughout the night.

I also posted this thread about my TPN treatment: http://www.crohnsforum.com/showthread.php?t=37402

If you want to check it out, I posted a bunch of stuff.



I've been on TPN for over 2 months now and gained back 25 lbs. I also felt my diarrhea got better while on it, not worse. I have been able to eat since before I was on TPN, but I was just so sick that it did nothing for me. Since then, I have continued to eat well.

If you have any questions, feel free to ask and I will do my best to answer.
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Current Medication
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TPN infusion (12 hour cycle every night)
Escitalopram 10mg - once daily
Lomotil - (2.5mg) up to 3 times daily
Ursodiol 500mg - twice daily
Align Probiotic - once daily
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09-07-2012, 01:24 PM   #15
RugbyTrooper12
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I was put on TPN after having my third Small bowel obstruction episode this summer. I was given the picc line in the hospital and recieved tpn for about a week then i was discharged with TPN to be given at home. I have been on it now for atleast another two weeks and just talked to my NP and she added 600 more calories to my 1,400 calorie bag so that should take care of my starvation as i am only on a clear liquid diet. Because of the bowel rest it is difficult not to want to eat something because ive always had an appetite from watching pizza hut or papa johns commercials, even anything that dealt with food i wanted it. But i am thankful i can enjoy the little i have im looking into herbal teas and even became a black coffee drinker with a little splenda. Hopefully when i see my G.I. doctor this tuesday september 11 (My condolences to anyone that lost someone close 11 years ago), and find out what plan he wants to do because i would love to work up my diet.

Current meds im on
Diagnosed Winter 2010, Crohns
1.Humira
2.Prednisone
09-07-2012, 04:29 PM   #16
Starla86
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Its been a long time since Ive posted, but Im back and this time on TPN at home I had a full obstruction 8-8-12 and spent the next 17 days in the hospital. I was really hoping for a longer remission period but it is what it is. So now Im looking at 4 weeks of home TPN with only a liquid diet, then my GI and I are debating if this is my long term option? I would love some in put from anyone that has been on TPN long term. Thanks
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DX Crohn's 2010
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Currently on:
TPN 12 hour cycles
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Protonix
Lasiks
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Valium
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Was taking:
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09-08-2012, 07:21 PM   #17
RugbyTrooper12
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Same story Starla hang in there exact same situation i had an obstruction. Im on a clear liquid diet as well and its so hard watching the commercials and seeing family eat freely around you. Ive been on TPN for about 3 weeks since august and was just added 600 calories to my diet for a full 2,000.

DX Crohns Winter 2010
Obstructions during august now on full TPN, 12 Hour Cycle

Current Meds
Humira
Prednisone
09-08-2012, 09:48 PM   #18
Starla86
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Its nice to know that I'm not the only one going through this I wish you the best and that you heal quickly!!
09-08-2012, 09:59 PM   #19
Tenacity
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Quoted from wikipedia

Long-term PN is occasionally used to treat people suffering the extended consequences of an accident, surgery, or digestive disorder. PN has extended the life of children born with nonexistent or severely deformed organs. People have survived on total parenteral nutrition for more than 35 years, living fully productive lives.
09-09-2012, 12:28 AM   #20
steve55
 
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I don't have first hand knowledge but I read that TPN does not provide ideal nutrition and is a temporary or last resort. I think if its possible, Enteral Nutrition with a formula like Vivonex would be the way to go provided that your intestines would tolerate that. I don't know what your situation is, but this alone might put you in a state of temporary remission. Perhaps you can find something else to work in order to avoid surgery. Make sure to explore all options before going under.
05-14-2013, 06:56 PM   #21
RichardSchulz
 
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I was on TPN from the age of 16 to 21, that was a long time ago, i am now 52

I am now again on TPN permanently so far its been 4.5 years so i have close to 10 years practical experience, I receive 2 liters of TPN solution and 2 liters of saline through a dual luman central line.

The need is due to a severe case of Crohns 7 bowel resections, illeostomy with a total remaining amount of intestine at a whopping 183cm 5 feet, everything is gone except that small section of small bowel, not enough absorptive surface to sustain nutritional needs.

I could probably write a couple pages but instead of trying to cover it all if you have any questions I would love to take a look...
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Medications:* Prednisone (hate it) * Pentasa
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05-14-2013, 10:56 PM   #22
Traumanurse
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I had TPN for a year trying to rest my bowel from unrelenting Crohns. Same as some on here, I had a central line, and hooked myself up each night. Gained a lot of weight though on that and steroids. It's really OK for people to learn to do this with sterile technique for themselves at home.

I ended up with a resection, then could eat again, but all in all, don't fear it if possible. It can be a really effective treatment in the right circumstances just like Richard said.
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