TOTAL PARENTERAL NUTRITION

Abstract

Surgical patients often present with conditions that have either
impaired ability to maintain their nutrition before operation or have made it impossible for them to obtain optimal
nourishment by conventional means after surgical intervention. As rationing of the health care services became an
increasing reality, the pressure to justify intervention such as nutrition support was intensified. The study was designed
to see the indications, management and anticipated complications of total parentral nutrition in adult surgical patients.
Design: Retrospective controlled study. Place and Duration of Study: During August 1997 to August 1998 at surgical
department Pakistan Naval Ship (PNS) Hospital Shifa Karachi. Material and Methods: 30 indoor patients were
selected. They were divided into three groups according to the pathological entities. After assessing nutritional status,
providing emergency treatment of relative pathology and calculating calories, central line was maintained by
approaching subclavian (76.6%), femoral or antecubital vein. TPN was monitored, clinically and with laboratory
investigations. Results: The group-I lagged approximately three days behind the others in achieving goal calories.
Weight gain in most of the patients was significant after two weeks. Initially all three groups showed hyperglycemia,
which was tapered by regular insulin over a Period of 3 to 3.5 days and rescheduling the nutrient substrates. Albumin
did not change significantly. Catheter sepsis was evident in third group. Conclusion: It was concluded that Judicious
use of TPN by thoughtful and conscientious nutritionist surgeons in surgical patients decreased morbidity/mortality rate,
improved quality of life, with smooth recovery, convalescence and rehabilitation, decreased hospital stay and
acceptable cost: benefit ratio.