What is TPN?
TPN for Crohn's or ulcerative colitis
TPN, or total parenteral nutrition, can be defined as being “fed” medical nutrients mixed in a special way to make up for nutritional deficits – or malnutrition, in many cases.
As defined by the Mayo Clinic, “Parenteral (not by mouth) nutrition, often called total parenteral nutrition, is the medical term for infusing a specialized form of food through a central line (intravenously). The goal of the treatment is to correct or prevent malnutrition.”1
What does TPN consist of?
TPN consists of nutrients, vitamins, fats, carbohydrates, electrolytes, and other elements that one's body may be deficient in. It is a pharmacy-mixed solution made specifically for the patient's needs. This depends on labs drawn several times a week to ensure the patient has a balanced formula to replace those nutrition deficiencies.
Most who use TPN also inject certain vials of fat and lipids and vitamins that can be mixed in the bag right before use, then shaken so the whole bag is thoroughly mixed and ready to be infused.
Why is TPN used for Crohn's and colitis patients?
Currently, I’m using TPN 24/7, as I had a very rough 6+ months of malnutrition, being in and out of IBD flares, as well as gastroparesis (which means paralysis of the intestines). I was experiencing severe dehydration, and obstructions from being so impacted. I couldn’t eat or drink anything and keep it down. For me, it was the only/best course of treatment, even though it made me lose my mind a little bit.
TPN is also used for many medical deficits, like gastroparesis, as well as for other forms of IBD. It's used during cancer treatments, for patients who experience severe malnutrition, for certain esophageal issues, among many other uses. Per the Mayo Clinic, “People whose digestive systems either can't absorb or can't tolerate adequate food eaten by mouth use parenteral nutrition."1
How does the process of TPN work?
After getting the vials of lipids and vitamins, and the bag is all set to go, there is a system that each of us goes through – not all the same. It can take up to 30-45 minutes of getting everything prepped and primed.
For me, after I’ve primed my tubing (gotten all of the long tubing filled with the TPN formula), I get my PICC line out and start wiping down each lumen (ports where TPN is connected, and where meds are injected, saline infusions among other meds are injected, like IV antibiotics, blood infusions, etc.).
Every patient on TPN has a different formula. They also have different access points, such as a G-tube (gastrostomy) through the abdomen, NJ tube through the nose, PICC lines, midlines, and occasionally ports.
Everything must be kept very sterile, clean, and dry to prevent infection. And yet, there is still a chance a patient may develop sepsis, which is also terrifying. There are a lot of complications that can arise from TPN, especially if your central line is accessed very frequently.
There are a lot of steps to get your central line prepped (injecting saline in the lumen you use for TPN) before you start infusing. TPN is very thick and sticky, so it's really important to flush the line with saline and heparin to make sure it doesn't get clogged.
Mine has clogged several times, and I've had several midlines and PICC lines placed due to the build-up of formula in the line. I've also had to use a medication (called Alteplase) to bust clots in both lumens. It's a medication that's used for strokes as well. In the last month, I've experienced this 3 times and have needed the clot-busting medication. Seems I've got some pretty crummy luck with it comes to PICC lines, and I've had far too many since about 5 years ago.
Check out part 2 of this article, "The TPN Process," to read more about my personal experience with total parenteral nutrition. And share in the comments below: Do you have any experience with TPN because of your Crohn's or ulcerative colitis?
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