NOTE: Nothing in this article is intended to convey medical advice.
There are many conditions that can make it difficult for your body to get all, most, or any of the nutrition it needs on its own, such as short bowel syndrome (SBS) or Crohn’s Disease. In these cases, your digestive system can’t absorb all of the nutrients from your food to keep you properly nourished. To prevent malnutrition, you may need an alternative form of nutrition that bypasses your gastrointestinal tract.
If you’ve recently found yourself in this situation, your doctor might have already told you about parenteral nutrition. You may still find yourself with questions about what parenteral nutrition is and how it works, though, and what it is you will be putting into your body.
Parenteral nutrition, or PN, is a unique medical therapy developed in the 1960s to sustain life and treat malnutrition. Parenteral nutrition is the administration of nutrition directly into your body through your bloodstream rather than through your intestinal tract. When you need PN to provide for all of your daily nutritional needs rather than a portion, it is called total parenteral nutrition, or TPN.
The prospect of going on parenteral nutrition might sound frightening at first, but it is nothing to be afraid of. Many people just like you have gone on parenteral nutrition and live meaningful, happy lives.
What TPN Is… and What TPN Is Not
TPN is a unique medical therapy that is oftentimes not well understood by the general public. Misunderstandings about what total parenteral nutrition is and how it works are the cause of the frightening first impressions you might have about being on TPN if you’ve just been told by your doctor that you need it.
- Total Parenteral Nutrition is not a disease—it is a therapy that is used to help treat various diseases or conditions.
- TPN is not a “death sentence,” as some who are new to the world of Total Parenteral Nutrition might fear upon being told about it by their doctor. TPN delivers nutrients to the patients who rely on it; in that sense, parenteral nutrition sustains life.
- TPN does not diminish a patient’s quality of life—in fact, by staving off malnutrition, Total Parenteral Nutrition can enable you to thrive with a newfound quality of life
- Receiving all of one’s nutrients from Total Parenteral Nutrition does not mean patients cannot eat. How much a TPN consumer can or should eat and whether they have any other dietary restrictions is between them and their dietician or medical team. Many TPN consumers are still social eaters!
- In the past, TPN left people feeling confined to a hospital or to their homes. Today, though, technology has advanced significantly, and Total Parenteral Nutrition patients are empowered to continue doing many of the things they love to do. In fact, today, many patients receive TPN treatment in the comfort of their own homes—approximately 40,000 people in the US today.
- Home TPN doesn’t mean Total Parenteral Nutrition consumers are stuck at home. Home TPN consumers can still have active lives. For example, traveling with home TPN, whether for your career or for family gatherings and vacations, is still doable for Total Parenteral Nutrition patients – it just requires more planning, with the help and advisory support of your doctor or medical team and your pharmacy.
Long-term home Total Parenteral Nutrition consumers are not alone
TPN consumers can and do still have active social lives, and being a Total Parenteral Nutrition consumer connects you to a worldwide community of patients like you.
For example, our Nutrishare Neighborhood, a virtual community of Total Parenteral Nutrition consumers, caregivers, and medical professionals, connects TPN patients just like you who are living their best lives — such as Todd Friedman, who hasn’t let his Crohn’s Disease stop him from traveling to all fifty states!
Hear more about patients like Todd and other home TPN patients who are thriving on home Total Parenteral Nutrition in our Nutrishare Neighborhood or follow their stories in our Sharing Newsletter.
Who Uses TPN
There are many reasons why a patient may require home parenteral nutrition. The most common are intestinal dysfunction from short bowel syndrome (SBS), Crohn’s disease, and intestinal dysmotility. In some cases, a patient with an esophageal tear might require parenteral nutrition for the short duration of the healing of the injury.
Short Bowel Syndrome
The main cause of SBS is surgery to remove part of the intestines due to disease, injury, or birth defect. Diseases common to SBS include various types of cancer, Crohn’s disease, intestinal dysmotility, midgut volvulus, or injury to the intestines through trauma.
SBS patients struggle to absorb nutrients through their own gastrointestinal tract. Depending on the severity of the condition, partial or total PN is often used to provide nutritional support and prevent malnutrition.
Crohn’s Disease
Crohn’s disease is a chronic inflammatory disease of the intestines, especially the colon and ileum, associated with ulcers and fistulae. Crohn’s disease can lead to SBS and it is a common underlying disease for patients who require parenteral nutrition.
Crohn’s patients may sometimes struggle to absorb nutrients, or traditional feeding methods may cause such severe complications and pain that parenteral nutrition is required for nutritional support instead.
Intestinal Dysmotility
Intestinal dysmotility is a disorder that affects gastric motility through an abnormal contraction of the intestinal muscles. Intestinal dysmotility patients often require parenteral nutrition due to their inability to absorb nutrients or complications associated with traditional feeding methods.
How Home TPN Works
TPN treatment involves having an intravenous catheter that connects a bag of nutritional mix directly to your bloodstream. Some people need to be hospitalized while they receive TPN. Others can administer their TPN in the comfort of their own homes—this is called home total parenteral nutrition (home TPN).
The Two Types of Parenteral Nutrition
There are two types of PN, depending on where in the body the catheter is attached. Peripheral parenteral nutrition (PPN) involves supplying PN to a vein in one of your limbs, such as the cephalic, basilic, or brachial vein in the arm, through a peripherally inserted central catheter.
The other type of PN, central venous nutrition (CVN), connects a central venous catheter, also known as a CVC, central line, or c-line, to a large central vein, such as the internal jugular vein in the neck, or the subclavian vein in the chest.
Both types of PN have their own advantages and disadvantages and their own best use cases. CVN is more commonly used for long-term TPN, while PPN is more commonly used for partial and short-term PN.
TPN requires a high volume of liquid to be infused into the patient’s body to provide nutritional support, and so the central line is typically placed in the large blood vessel of the aorta in the patient’s chest in order to efficiently pump as much liquid nutrition into the body as quickly as possible.
CVN commonly involves an implanted port, also known as a venous access port—a device implanted under the skin of a patient’s chest with an attached catheter inserted into the superior vena cava. Implanted ports are often used for patients who will be on Total Parenteral Nutrition for many years. Depending on their needs, a patient might infuse for anywhere between 6 – 24 hours a day.
Home TPN Supplies and Equipment
Total Parenteral Nutrition can be safely and effectively administered outside of a hospital setting for many TPN patients, allowing them to continue living their lives with fewer significant disruptions. Home TPN generally involves at least several pieces of equipment:
- Your central line, installed under the supervision of your physician
- Bagged home TPN formula, shipped to your house by your home Total Parenteral Nutrition provider and stored in a refrigerator
- A TPN pump designed to administer Total Parenteral Nutrition formula through your central line into your vein, along with an IV pole or hook
- A TPN solution administration set
- Syringes, alcohol wipes, and a sterile barrier
Keeping TPN supplies and equipment sterile, particularly keeping the central line clean is of the utmost importance for TPN consumers. Making sure the central line is sterile is critical to the prevention of conditions such as CLABSI, or central line-associated bloodstream infections, and to consumer comfort while on TPN.
Administering a day’s worth of TPN formula typically takes about 10-12 hours, so many home TPN patients choose to administer their TPN overnight. Modern advancements in pumps and formula storage have made home TPN far less burdensome and disruptive to one’s life than in the past. Portable pumps, for example, which can be carried in a backpack, enable home TPN patients to administer TPN on the go and without the need for an IV pole or hook.
What’s in a TPN bag?
Generally, a TPN bag will consist of a prepared solution with added components to more precisely adjust the proportions to suit an individual patient’s unique needs.
TPN delivers nutritional medication directly to the bloodstream when your body can’t get enough or any nutrition from food. The nutritional mix is a formula of macronutrients, which are the nutrients your body needs the most of, and micronutrients, which are the vitamins and minerals you would get in your food.
The three main components of TPN:
The main three macronutrients in TPN are lipid emulsions, proteins, and dextrose.
- Lipid emulsions in TPN provide calories and prevent deficiency of fatty acids. Generally, 25-30% of the total calories you receive on TPN come from lipids.
- Proteins in TPN provide essential and non-essential amino acids for the body. A healthy adult requires 0.8 to 1 gm of protein per kilogram per day, though this figure varies depending on one’s condition.
- Dextrose monohydrates in TPN provide the carbohydrates your body needs.
Micronutrients in TPN include vitamins, minerals, and electrolytes.
TPN formula is not something you would buy off-the-shelf; rather, it is unique for each patient. The proportions of the macronutrients and micronutrients in TPN must be calibrated based on a patient’s needs. Too little or too much of any one component can be harmful. For example, excessive carbohydrate supplementation can result in hyperglycemia.
Generally, a TPN bag will consist of a prepared solution—a general three-in-one mixture of the three main macronutrients in water and electrolytes—with added components to more precisely adjust the proportions to suit an individual patient’s unique needs. The prepared solution is adjusted at a compounding pharmacy to suit the patient’s nutritional needs according to their prescription, taking their age, gender, nutritional requirements, and underlying diagnosis into account. All parenteral nutrition formulas are sterile compounded in a regulated compounding pharmacy inside of a clean room environment.
It’s important to have a dialogue with your doctor and pharmacy in order to ensure that as your life goes on, your TPN continues to be optimized to best suit your nutritional needs.
Getting started with Nutrishare
We’ve been an exceptional home TPN provider for the past 30 years, prioritizing individualized treatment, one-on-one clinical care, and bringing our patients and their doctors into a community of support. We are the only nationwide pharmacy specializing exclusively in parenteral nutrition for patients who require long-term support.
We offer to our patients an award-winning team of clinicians, convenient and rapid shipping across the US, a simplified online ordering platform, and extensive support when you travel, along with a nationwide community of patients and caregivers through our Nutrishare Neighborhood.
Nutrishare is the only nationwide pharmacy that specializes in parenteral nutrition for the long-term consumer. We ship to 48 states so you can travel throughout the country with peace of mind, knowing that we will ship to your location as you travel. Our clinical staff has made a career-long focus on how to best care for patients who require parenteral nutrition, and we are dedicated to putting patient choice first in our support.
To learn more about partnering with Nutrishare for your home TPN services, get started today with an insurance pre-check, or call us at 1-800-HOME-TPN (466-3876).