Parenteral Nutrition (PN) Overview

Definition and Purpose

• Parenteral Nutrition (PN) is a medical and nutritional treatment.
• Also known as Total Parenteral Nutrition (TPN).
• Administered when a patient cannot consume food orally due to:
  • Illness
  • Surgery
  • Non-functioning stomach or bowel.
• Can supplement nutrition when oral or tube feeds are insufficient.

Administration

• Prepared by the pharmacy department in certain hospitals.
• Administered in a specialized bag through an intravenous (IV) catheter using a pump.

Hospitals Preparing PN

• Within Horizon Health Network:
  • Dr. Everett Chalmer Regional Hospital
  • Miramichi Regional Hospital
  • Moncton Hospital
  • Saint John Regional Hospital
  • Upper River Valley Hospital
• Saint John Regional Hospital also prepares home PN for eligible patients.

Components of Parenteral Nutrition

• Nutrients included:
  • Protein (amino acids)
  • Carbohydrates (dextrose)
  • Fat (lipids/fat emulsions)
  • Electrolytes: sodium, potassium, calcium
  • Vitamins and Minerals

PN Team

• Includes:
  • Specialist doctors (gastroenterologist, surgeon, pediatrician)
  • Nurses
  • Dieticians
  • Pharmacists
• Responsible for ensuring the PN meets individual needs.
• Available for support and to address questions or concerns.

Preparation Process

• Prepared in a sterile room by pharmacy staff.
• Use of a compounder machine for automatic preparation.
  • Order entered into a compounder computer program.
  • Label printed, compared, and scanned to ensure accuracy.
• Some hospitals use premixed bags, carefully selected by the PN team.
• Double-checked by pharmacy team before administration.

Storage and Administration

• Stored in a refrigerator on the nursing unit.
• Typically administered continuously over 24 hours.
• Lipids may be administered separately over shorter periods (e.g., 12 hours).

Monitoring and Adjustments

• Regular review of medical conditions and blood work by the PN team.
• Adjustments made to PN ingredients as necessary.
• Monitoring for complications (e.g., infections, changes in blood work, IV access issues).

Discontinuation

• Most patients do not require PN after hospital discharge.
• PN stopped once adequate nutrition is achieved through oral intake or feeding tube.
• PN team discusses reasons for stopping with patients if necessary.

Support

• Continuous support from the PN team available for any queries or issues related to PN.
• Encouragement to consult with physician, nurse, dietician, or pharmacist for concerns.