-is feeding a person intravenously, by passing the usual process of eating and digestion. The person receives nutritional formulas containing salts, glucose, amino acids, lipids and added vitamins. It is called total parenteral nutrition (TPN) when no food is given by other route.

-is provided when the gastrointestinal tract is nonfunctional because of an interruption in its continuity or because its absorptive capacity is impaired. It has been used for comatose patients, although enteral feeding is usually preferable, and less prone to complications.

- The normal adult requires a minimum of 1200 to 1500 cal/day to carry out normal physiologic function.

- TPN may be the only feasible option for patients who do not have functioning GI tract or who have disorders requiring complete bowel rest, such as the following

some stages of Crohn’s disease or ulcerative colitis, bowel obstruction, certain pediatric GI diorders,e.g., congenital GI anomalies, prolonged diarrhea regardless of its cause, or short bowel syndrome due to surgery. ( The Merck Manual, 2008).

-TPN will drip through a needle or catheter placed in vein for 10-12 hours, once a day or five times a week.

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-Many solutions are commonly used. Electrolytes can be added to meet the patient’s needs.

-Solutions may vary depending on other disorders present and patient’s age, as for the following:

-for renal insufficiency not being treated with dialysis for liver failure: reduced protein content and a high percentage of essential amino acids.

-for heart or kidney failure: limited volume intake.-for respiratory failure: a lipid that provides most of

nonprotein calories to minimize CO2 production by carbohydrate metabolism.

-for neonates: Lower dextrose concentrations. (17 to 18%)

1. Verifies doctor’s prescription.2. Explain the procedure to the patient and significant others.3. Secure consent form from the patient and/ or authorized members of

the family.4. Prepares parenteral solution and all other devices needed for the

parenteral administration taking into consideration the mode of administration such as:

a. Peripheral accessb. Central access5. Assesses patient and choose suitable vein, location, and get baseline

vital signs.6. Check the integrity and functionality of the parenteral solution and IV

devices.

1. TPN solution not opened or used should be returned to pharmacy can be credited.

2. Administer TPN solution at constant rate.3. Change tubing and filter if the system slows.

Flushing of the system shall be avoided.4. Assess and document vital signs, glucose

monitoring, I&O, and routine weights accurately. This is to monitor the effectiveness of TPN therapy.

5. Observe for skin rashes, flushing, color, or other adverse reaction and notify the Doctor.