Lesson Outline: Parenteral Feeding
I. Introduction to Parenteral Feeding
A. Definition: What is parenteral feeding?
o Also known as Total Parenteral Nutrition (TPN) or intravenous feeding.
o Administration of nutrients directly into the bloodstream, bypassing the digestive
system.
o Provides all or most of the patient's nutritional requirements.
B. Purpose: Why is parenteral feeding used?
o To provide nutrition when the gastrointestinal (GI) tract is non-functional,
impaired, or requires rest.
o To prevent or correct malnutrition.
o To support healing and recovery.
C. Components of Parenteral Nutrition (PN) Solutions:
o 1. Macronutrients:
Dextrose (carbohydrates): Primary energy source.
Amino Acids (proteins): For tissue repair and synthesis.
Lipids (fats): For essential fatty acids and concentrated energy.
o 2. Micronutrients:
Vitamins (water-soluble and fat-soluble).
Trace Elements (e.g., zinc, copper, selenium, chromium).
o 3. Electrolytes: (e.g., sodium, potassium, chloride, calcium, magnesium,
phosphate).
o 4. Water: For hydration.
II. Types of Parenteral Feeding
A. Total Parenteral Nutrition (TPN):
o Administered via a central venous catheter (e.g., subclavian, internal jugular,
PICC line).
o Used for long-term nutritional support.
o Can provide highly concentrated solutions.
B. Peripheral Parenteral Nutrition (PPN):
o Administered via a peripheral intravenous (IV) line.
o Used for short-term nutritional support (typically <14 days).
o Solutions are less concentrated due to the risk of phlebitis in smaller veins.
o Not suitable for patients with high caloric needs.
III. Indications for Parenteral Feeding
A. Non-functional GI Tract:
o Severe malabsorption (e.g., Crohn's disease, short bowel syndrome).
o Intestinal obstruction.
o Paralytic ileus.
o Severe pancreatitis.
o Prolonged vomiting or diarrhea.
B. GI Tract Requiring Rest:
o Severe inflammatory bowel disease.
o Bowel fistulas.
o Pre- and post-operative support for major GI surgery.
C. Inability to Meet Nutritional Needs Orally/Enterally:
o Severe anorexia nervosa.
o Extensive burns.
o Hyperemesis gravidarum.
o Severe trauma or critical illness.
IV. Administration and Monitoring of Parenteral Feeding
A. Central Venous Access Devices (CVADs):
o Types: PICC lines, non-tunneled central catheters, tunneled catheters, implanted
ports.
o Insertion and care.
B. Infusion Management:
o Infusion pumps for precise rate control.
o Gradual initiation and tapering.
o Aseptic technique during solution preparation and administration.
C. Patient Monitoring:
o 1. Clinical Monitoring:
Daily weight.
Fluid balance (intake and output).
Vital signs.
Signs of infection at catheter site.
o 2. Laboratory Monitoring:
Blood glucose (frequent monitoring, especially initially).
Electrolytes (Na, K, Cl, Mg, Ca, P).
Liver function tests (LFTs).
Renal function tests (BUN, creatinine).
Triglycerides (if lipids are infused).
Complete Blood Count (CBC).
V. Complications of Parenteral Feeding
A. Catheter-Related Complications:
o Catheter-related bloodstream infection (CRBSI): Most serious.
o Pneumothorax/Hemothorax (during insertion).
o Air embolism.
o Catheter occlusion.
o Thrombosis.
B. Metabolic Complications:
o 1. Hyperglycemia/Hypoglycemia: Due to glucose intolerance or abrupt
cessation.
o 2. Electrolyte Imbalances: (e.g., hypokalemia, hypophosphatemia,
hypomagnesemia).
o 3. Refeeding Syndrome: Potentially fatal shift in fluids and electrolytes in
malnourished patients.
o 4. Liver Dysfunction: TPN-associated liver disease (cholestasis, steatosis).
o 5. Gallbladder Complications: Sludge, gallstones.
o 6. Bone Disease: Metabolic bone disease (osteoporosis, osteomalacia).
C. Other Complications:
o Fluid overload/dehydration.
o Allergic reactions to components.
VI. Transitioning Off Parenteral Feeding
A. Gradual Weaning: Slowly decreasing PN as enteral/oral intake increases.
B. Monitoring Tolerance: Assessing patient's ability to tolerate oral/enteral nutrition.
VII. Conclusion & Summary
A. Review: Recap of parenteral feeding, its types, indications, administration, and
complications.
B. Emphasis: Highlight the critical role of careful patient selection, meticulous aseptic
technique, and rigorous monitoring for safe and effective PN therapy.
C. Q&A and Discussion.
