From immediate caregivers to siblings, friends, extended family and others who interact with a total parenteral nutrition (TPN)-dependent child, there are bound to be a lot of unanswered questions about why some children get their nutrition in this way. Our Intestinal Rehabilitation Program team understands this and has put together answers to some of the most popular questions asked about intravenous nutrition. Please note that this information is not intended to replace specific information or care instructions provided by your child’s health care team.
What is total parenteral nutrition (TPN)?
Total parenteral nutrition (also called TPN and intravenous nutrition) is a special mixture of glucose, protein, fat, vitamins and minerals that is given through an IV into the veins in order to provide necessary nutrients when a child cannot consume or absorb enough food or nutrients to grow and be healthy. The exact prescription of TPN depends on each child’s condition, estimated nutrition needs, blood work levels and whether the child is receiving other sources of nutrition such as through a feeding tube or if he or she is also eating by mouth. The TPN solution is usually infused continuously over several hours of the day and never actually enters the digestive system.
Children may need TPN for a variety of reasons and medical conditions, including:
- Short bowel syndrome and other conditions that make it difficult for the body to absorb nutrients through the intestinal tract
- Severe, chronic vomiting and/or diarrhea, and/or malabsorption affecting growth
- Intolerance to regular diet or feedings using the stomach and intestines
- Difficulty eating or absorbing nutrients due to cancer treatment.
How is the nutrition delivered into my child’s vein?
The TPN comes as a mixed solution in a bag and is given like an IV or intravenous fluid using a pump. The TPN is infused into the child’s blood vessels through a central catheter (or small tube) that was placed during a surgery. This catheter may enter into the chest or arm, but it will always end near the heart.
How long will my child need to be on TPN?
The length of time of a child will be on TPN varies and depends upon the child’s medical condition. It is important to speak with your child’s health care team about their expectations for the course of treatment.
Will my child be able to do “normal things” on TPN?
The goal of the CHOC Intestinal Rehabilitation Program is to work with patients and their families to make life as normal as possible while on TPN. Depending on each individual child’s condition and/or severity of illness, he or she may need a little or a lot of nutrition from TPN. This will affect how many hours in a day the child will need to receive their TPN. Many times the TPN pump can be worn in a special backpack to allow the child to participate in normal daily activities while receiving their TPN infusion. Your child’s health care team will provide specific information regarding your child’s needs and advice on how to make life feel more normal.
Will my child be hungry from TPN?
Typically children on home TPN do not feel hungry if receiving all their nutrition from TPN. The TPN nutrients go right into your child’s blood stream. If your child feels hungry, then changes can be made to the TPN and/or what your child eats. Be sure to speak with your child’s health care team if they are feeling hungry.
What are the risks of TPN?
There are three common risks associated with TPN:
Infection. It is important to monitor your child’s central line site for signs of infection, including warmth, redness, tenderness, irritation, pain, swelling or discharge. If you notice any of these, call the child’s health care team immediately. Also, if your child is not acting normal, is lethargic (sluggish or less active than normal), or has fever, this could be a sign of an infection and you should also call the child’s health care team immediately. Learn more about preventing infections.
TPN liver disease or damage: TPN increases the risk of liver disease, especially in infants, young children, children who are on TPN for a long time and those who are not receiving much nutrition through their GI tract. Patients undergo frequent blood tests to monitor the effect of the TPN of the liver.
Growth: Although TPN is a life-saving therapy that can improve nutrition status and growth. It is not the same as eating a balanced diet. Sometimes children who are on TPN for a long time without eating a regular diet can be smaller in size than children who are not on long-term TPN.
Can my child still eat while on TPN?
Some children are placed on TPN as a way to supplement the food they are eating. In cases like these, the child’s health care team will likely recommend the child continue eating.
In some instances, children who are put on TPN are unable to eat by mouth and receive nutrition through a tube in their stomach. Other children may have a problem with their stomach or intestines and need to have all of their nutrition through TPN.
Is there a special diet my child should follow while on TPN?
Not always. Sometimes there may be special diet recommendations your health care team may make for your child. Ask your health care team if your child needs to follow a special diet.
How do I best care for my child’s central line?
It is important to take proper care of your child’s central line in order to reduce the risk of infection. Learn how to best care for your child’s:
How often will my child need to have their blood drawn?
Each child on TPN has different needs. It is important for all patients to be monitored often to make sure the TPN is providing exactly what the child needs. The child’s health care team will provide specific recommendations on how often your child needs to have his or her blood work checked. Typically, blood work is done every one to four weeks.