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Key Points: Consider TPN for longterm nutrition when:

1. Small bowel absorption is severely reduced (typically TPN is needed when there is less than 100cm functional small intestine)

2. The patient has very poor motility

Consider TPN for shorter-term nutrition when:

3. Patient is significantly malnourished and unable to tolerate enteral feeding. Recommended duration:

  • PPN= No more than 2 weeks. Requires a large bore catheter in the arm
  • TPN= Duration is dependent on indication

Key Points:

TPN should be avoided when:

1. Patients retain a functional gut

2. Patients have fungemia and within 24h of its clearance

3. For PPN: Patients with high energy requirements

Key Points: The main complications:

1. Catheter infection

  • Treat with lock therapy to improve efficacy of antibiotics against bacteria forming biofilms.

2. Catheter occlusion

3. Venous thrombosis

4. Glucose dysregulation

5. Hypertriglyceridemia

6. Liver/gallbladder dysfunction

  • Most patients on longterm TPN develop hepatic steatosis, but this can be limited by careful nutritional titration.
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