LONG TERM FEEDS

6.4 PARENTERAL ALIMENTATION
Parenteral alimentation involves the continuous infusion of a
Hyper-osmolar solution containing carbohydrates, proteins, fats
and other necessary nutrients.
Delivered through an indwelling catheter, inserted into the superior vena cava.

Intravenous Hyper-alimentation is indicated in patients with
* high alimentary tract obstruction gastric carcinoma
* pyloric obstruction, surgical patients with prolonged
paralytic ileus or
* adult patients with functional gastrointestinal disorders
and malignancy.

HOME BASED TPN(Total parenteral Nutrition)
Patients can be discharged, nutrient support continued at home if needed.

Hickman/Broviac cuffed polyurethane catheters Fig 5.3 make it
possible to deliver TPN at home.
Subcutanous implantable systems Fig 5.4 are also advocated to achieve this objective

The information provided in the text of this
section should be adequate to identify the guiding principles for
the fluid electrolyte and nutritional requirements of different
surgical patients.

Definitions


Hyper-alimentation
This is the introduction of large amount of calories either by a
tube (in the unconscious patient) or small intestines if the GI
tract is functioning.
If not special calories containing fluids can be introduced intravenously, this required when the GI tract
is diseased.

Total Parenteral Nutrition
In case of disease of gastro intestinal tract the nutrition of
the patient has to be maintained entirely through the intravenous
route.
Special preparations are available to supply all nutrients
(fats, proteins, carbohydrates) to meet calorie requirements.
Micro-nutrients are also provided.
This is total par-enteral nutrition.

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