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Total parenteral nutrition -TPN or hyperalimentation, is the practice of feeding a person but not via mouth but blood. It is normally used during surgical procedures. It has been used for patients in coma although enteric (tube) feeding is adequate and effective because it is less complicated. Chronic TPN is used to treat patients suffering from the accident or a complicated surgery. On the TPN's simplest way a bag of liquid nutrients is added to a patient's intravenous drip.

The intravenous injecting of nutrients is called parenteral feeding. It can be given to a patient orally or via tube intravenously, and this type of nutrition is called parenteral nutrition. Patients who are malnourished, at risk to be like that or with unreachable gastrointestinal tract need an intravenous injecting of nutrients.

The access on skin can not be used for anything else but injecting of nutrients. The solution for parenteral nutrition is thrombogenicand and conduct like a vein irritant. Parenteral feeding is actually direct access and provides the concentrated formula to flow into main vessels. A peripherally expectorate central catheters (PICC) is done with an aseptic technique. Intravenous feeds of low osmolality and neutral pH is ascent. TPN solutions are manufactured in sterile condition in plastic sterile 3 liter bags.

TPN solutions are injected intravenously and have a right mixture of essential and non-essential amino acids micronutrients glucose fat and electrolytes. The solution is iso-osmotic lipid emulsions that are an energy solution that also alleviate a vein irritation. The solution also has a small concentration of glucose that inhibits hyperosmolar dehydration. The way parenteral nutrition is given to patient is gradually, at a continuous flow rate. The solution contains folic acid with vitamin B12 given separately from the injection.

The Complications - Re-feeding syndrome

The complications may occur with hypophosphataemia, along with an electrolyte disturbances due to a solution feeding stimulation of the cellular electrolytes. It takes about 4 days of re-feeding to clinical features to thrive. And later on, that may cause • hypotension,• rhabdomyolysis,• seizures,• respiratory failure, • cardiac failure,• arrhythmias,• coma.

Catheter complications

The instantaneous complications are pneumothorax, haemothorax, cardiac tamponade arrhythmias and hemorrhage. Catheter complications are long termed and are venopulmonary fistula, subacute bacterial endocarditis, chylothorax, pulmonary embolism pleural pericardial effusion and thrombosis.

Possible Infection

Infections due to a parenteral feeding are septicaemia (that may end with death because of the catheter-related sepsis) enterococci and staphylococcal species. Also, there is a liver and gallbladder failure and slugging of gallbladder and gallstones. Hyperglycemia

Hyperglycemic patients have to get nutritional addictions, in which case glycemic control is absolutely necessary also a treatment with insulin and oral hypoglycemic agents is needed.

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