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TPN Home Infusion Overview and Experiences

Anna Lester, Eitan Medical
October 1, 2022

What is TPN?

TPN or Total Parenteral Nutrition is an infusion of nutrition directly into the bloodstream. It is designed to replace all the important nutrients that a person would normally be getting through their diet. It contains the following sterile chemical components:

 

  • Proteins
  • Fats
  • Carbohydrates
  • Vitamins (e.g., vitamin A)
  • Electrolytes (e.g., sodium)
  • Trace elements(e.g., zinc)
  • Water

 

The balance of these components is based on multiple nutritional factors and other baseline characteristics of the patient.

 

The percentage of each chemical component is decided and arranged by doctors, dieticians (nutritional experts), and pharmacists. The bags are kept refrigerated and are protected by a foil coating to keep the chemicals from spoiling from light exposure before use.

 

These infusions are delivered via small ambulatory infusion pumps, such as Sapphire Infusion Pump, to allow the patient more freedom and mobility.

Sapphire Multi Therapy Infusion Pump

How Does Total Parenteral Nutrition Work?

 

Parenteral nutrition bypasses the gastrointestinal (GI) tract, delivering directly into the bloodstream via a catheter (needle in the vein), for both temporary and long-term needs.

 

In long term patients, clinical reviews, including blood tests are required to ensure the correct balance is achieved as blood results can indicate whether there are nutritional deficiencies or excesses, requiring the recalculation of the formula.

 Why is TPN provided to patients?

Any person who is unable to get enough calories through their gastrointestinal (GI) tract is considered to have nutritional deficits and might need to receive TPN.

 

Nutritional deficits can result from a multitude of diseases including inflammatory bowel diseases such as Chrohn’s, short bowel syndrome,  Ischaemic Bowel disease, obstruction of the gastric tract, Cancer, and bowel surgery complications.

 

Premature babies may also require TPN if they are not absorbing the necessary calories or if their GI tract is insufficiently mature.

 

For some patients, TPN is temporary and just during a hospital stay. Other patients are discharged home with TPN and are trained by nurses on how to infuse at home.

 

Patients with chronic diseases can receive their TPN at home using a smart infusion pump such as the Sapphire Infusion Pump.

 

These patients become expert users and can connect the infusion to their catheter, most commonly by a port (Port-a- Cath – an implanter catheter or PICC line (peripherally inserted central catheter).

 

TPN is recommended only for cancer patients with a life expectancy of at least 2-3 months according to the American Society of Parenteral and Enteral Nutrition on palliative care (1).

 

Home Parenteral Nutrition (HPN) or TPN at home has been found in multiple clinical studies to improve quality of life, nutritional outcomes, and an increase in weight in cancer patients. (2,3,4)

 

Experiences with TPN vary according to the disease that causes the nutritional deficiency.

 

According to Gorski and Grothman, once the patient and family have mastered the aspects of TPN administration, the patient's lifestyle can remain somewhat independent, while maintaining an optimal nutritional status (5).

 

ASPEN clinical guidelines provide advice on when TPN is appropriate and provide best practices and day to day guidance for clinicians. For more information see the article from ASPEN: When Is Parenteral Nutrition Appropriate? - Worthington - 2017 - Journal of Parenteral and Enteral Nutrition - Wiley Online Library

TPN Illustration

Interviews with TPN Sapphire Infusion Pump users

What’s it like to live with TPN?

I feel waves of nausea every day” reported one 24-year-old male patient who receives TPN daily due to a rare condition Superior mesenteric artery syndrome (a digestive condition that occurs when the duodenum (the first part of the small intestine) is compressed between two arteries (the aorta and the superior mesenteric artery)).

 

” I cannot eat food due to the compression, so TPN is what keeps me alive. But I still feel hungry all the time, and sometimes I cheat, which just makes me vomit”.

 

I don’t always feel like having TPN. So sometimes I take a day off, but then my weight drops” stated a 65 year old male with Chron’s disease.

 

One female patient with Chron’s disease reported how she has been having TPN for so many years (12), it’s just a part of life and her daily routine of getting up and getting the kids ready for school.

 

She makes sure her infusion is finished in time so that she can be free and not connected for the school run. But there have been times she has just taken it with if needed. She loves the lightness of the pump that makes it possible to forget about the pump if needed.

 

I usually put it on before I go to sleep, wake up and then I have another couple of hours left to complete the TPN. I use it every night for 12 hours. I am very thankful that after all the trauma I have gone through from a work accident, I can still live a normal life.” Reported a 39-year-old male with 2 young children.

 

A horrific work accident involving entrapment in a construction machine resulted in the surgical removal of a large section of the GI tract resulting in an inability to absorb the necessary nutrients. Faith, family support and excellent medical care helped this man recover and continue his normal family life.

 

I disconnect my TPN and then I go to work. Sometimes I put the infusion pump in my backpack, and I leave for work with it before its completed. I have even flown with it and used it abroad. I got a pole made that is like a telescope and can fit in my travel bag so that I can infuse whilst I sleep if I need to go on a work trip.

 

Learn more about what its like to live with home intravenous nutrition needs. Visit the Oley FoundationStriving to enrich the lives of those living with home intravenous nutrition and tube feeding through education, advocacy, and networking”.

 

 

REFERENCES

  1. Gorski LA. The Impact of Home Infusion Therapies on Caregivers. Semin Oncol Nurs. 2019 Aug;35(4):370-373. doi: 10.1016/j.soncn.2019.06.010. Epub 2019 Jun 20. PMID: 31229340.
  2. Vashi PG, Dahlk S, Popiel B, Lammersfeld CA, Ireton-Jones C, Gupta D. A longitudinal study investigating quality of life and nutritional outcomes in advanced cancer patients receiving home parenteral nutrition. BMC Cancer. 2014;14:593.
  3. Culine S, Chambrier C, Tadmouri A, et al. Home parenteral nutrition improves quality of life and nutritional status in patients with cancer: a French observational multicenter study. Support Care Cancer. 2014;22:1867–1874.
  4. Girke J, Seipt C, Markowski A, et al. Quality of life and nutrition condition of patients improve under home parenteral nutrition: an exploratory study. Nutr Clin Pract. 2016;31:659–665.
  5. Gorski LA, Grothman L. Home infusion therapy. Semin Oncol Nurs. 1996 Aug;12(3):193-201. doi: 10.1016/s0749-2081(96)80037-4. PMID: 8857688.
  6. Worthington P, Balint J, Bechtold M, et al. When is parenteral nutrition appropriate? JPEN J Parenter Enteral Nutr. 2017;41:324–377.

 

 

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