Parenteral Nutrition

Parenteral nutrition (often called PN or TPN) is a source of nutrition we give through an IV when the body has difficulty tolerating digestion or absorption of food or formula. PN can provide carbohydrates, protein, fat, fluid, vitamins, and minerals. A custom (or specific) PN mixture is created based on each individual’s nutrition needs.

• Instead of going through the digestive system, the blood and body will absorb PN nutrients through an IV.
• The PN can be provided through a peripheral IV (PIV), a peripherally inserted central catheter (PICC), or other types of central IVs.
• A team with a dietitian, pharmacist, doctor, and nurse will work together to make sure the body is getting the nutrition it needs and tolerating the PN. This involves regular blood draws for laboratory monitoring. You can ask anyone on the team if you have questions about PN.

PN can:

• Be a life-saving therapy if it is the only option to nourish the body
• Be used temporarily until the body can digest and absorb food or formula
• Preserve the body's muscle and fat during a serious illness

As with any medicine, there are risks associated with PN. We will closely watch for complications. Also, because PN is given through a vein, there can be risks related to the IV. The following are some of the risks related to PN.

• A PIV is a small IV that is usually placed on the hand, wrist, foot, or scalp. • We can provide partial nutrition using a PIV for a few days.
• We cannot usually take blood from these IVs, so we will use a needle poke (syringe) for blood tests.
• IV insertion can cause inflammation or damage to the skin or the inside of the vein. This is called phlebitis (fleh-BI-tis) or infiltration. If this happens, we will need to place a new IV in a different location.

• Central line IVs last longer than a PIV. Full nutrition can be provided through central line IVs.
• A peripherally inserted central catheter (PICC) is one type of central line. It is a small tube that is placed in the upper arm or leg but delivers medicine, fluids, or liquid nutrition into a large vein near the heart. It is less likely to become irritated, inflamed, or damaged from the fluid being given through this IV.
• Sometimes, for very specific reasons, the team may need to insert a central line IV directly into the large vein in the neck or chest.
•  We can usually take blood from these central IVs without the need for a needle poke (for lab tests), and they usually stay in for as long as needed.
• Central line IVs can increase the chance of an infection in the blood. This can happen from bacteria on the skin or inside the body, like bacteria inside the gut (gastrointestinal (GI) tract). If this type of infection develops, IV antibiotics will be needed.
• There is also an increased chance for blood clots to form around the IV inside the veins. If this happens, we may need to remove the IV and give a blood thinning medicine to treat the clot.

• If we stop PN too quickly, it can cause low blood sugar (called hypoglycemia).
• Carbohydrates in the solution can cause high blood sugar (called hyperglycemia), especially together with certain medical conditions and medicines like steroids.
• Too much or too little of an electrolyte in the PN solution, or certain medicines during periods of illness can cause abnormal electrolytes. We will check the blood regularly to look for this. If needed, the medical team will change the electrolytes in the PN to help bring them to normal levels.
• PN can irritate the liver, especially in very young patients who need PN for a long time (weeks, months, or years). We will closely monitor liver function for any signs of irritation while on PN.

Many normal activities are possible while on PN therapy. Because the IV will be connected to a PN bag on a pole while in the hospital, some activities may be limited. When PN is needed outside the hospital, we will teach you what activities need to be avoided because of increased risk for infection (like swimming) or damage to the IV (contact sports).