Nutrition Therapies
All patients will undergo a complete nutritional analysis. Our physicians and dietitians work closely to determine recommendations regarding optimal TPN management, fluid and electrolyte management and special diet designed to meet the patient's specific needs. These recommendations are provided to the patient and referring physician to help achieve desired outcomes. Goals are to increase weight, decrease stool output, improve hydrations status and improve nutrient deficiencies.
A nutritional assessment by a dietitian experienced in the care of intestinal failure patients is important. An estimation of the caloric and hydration needs of the patient is needed to optimize an individualized oral and parenteral nutrition plan. In addition, SBS patients are at risk for a variety of micronutrient deficiencies because of physiological changes related to the altered bowel anatomy. For instance, vitamin B12 is absorbed in the terminal ileum and should be administered intramuscularly once a month to SBS patients with resections involving greater than 60 cm of the terminal ileum. Fat-soluble vitamin deficiencies, particularly vitamin D, are also common in these patients, as well as zinc and magnesium deficiencies. Consequently, it is important to monitor micronutrient levels periodically and treat deficiencies if they exist.
Education
To prevent complications from home nutritional therapies, the patient must become an active participant in his or her healthcare. The patient or a member of the patient's family must be willing to accept this responsibility as long-term nursing care is rarely covered by insurance. Initiating a patient on home PN requires extensive teaching on the method of administration and potential complications. A knowledge assessment by a clinical nurse specialist can help design an appropriate care plan for the patient. The patient should receive education about the disease process and methods to minimize complications related to the central venous catheter. It is also beneficial to provide information about support groups such as the Oley Foundation to allow the patient to build a network of positive support and an enhanced capacity to live with home PN.
What is TPN?
Total Parenteral Nutrition (TPN) is a method of feeding a person through an intravenous (IV) catheter. Physicians often order this method of feeding when a person is unable to absorb enough nutrition from the food they consume. TPN contains nutrients such as carbohydrates, lipids, proteins, vitamins, minerals, and water.
What is Enteral Feeding?
Enteral Feeding is a method of delivering liquid feedings though a tube and is used in instances where the gastrointestinal tract is functional, but the person cannot consume enough food to meet nutritional requirements.
Complications of Long Term TPN
Over the past 40 years, researchers and clnicians have identified the potential risks and complications to long-term TPN use. Dr. Buchman recently wrote a review published in Digestive Diseases and Sciences that reviews the relevant research in this area. If you would like to read this review, click here.
For more information about TPN, "Practical Nutritional Support Techniques," also by Dr. Buchman, is available for purchase at Amazon.com. You can also preview this book on Google Books.