Total parenteral nutrition, also known as hyperalimentation, is a form of intravenous feeding used to prevent or treat malnutrition in children who cannot eat enough to meet basic nutritional needs. Some of the many reasons why your child may require TPN are:
• Severe mouth and throat sores that prevent swallowing
• Severe nausea and vomiting
• Severe diarrhea
• Inability to chew or swallow normally
• Loss of more than 10 percent of body weight
TPN ensures that the child receives all of the protein, carbohydrates, fats, vitamins, and minerals she needs. The TPN is administered through the central venous catheter, but children receiving TPN can also eat solids and drink fluids.
My daughter needed TPN for two weeks after her stem cell transplant. They told us ahead of time that it would be necessary, and they were right. She got terrible sores throughout her GI tract and couldn't drink or eat. They just hooked the bag up to her Broviac. After a couple of weeks, she started gingerly sipping small amounts of water and apple juice. For some reason, I just didn't worry about her eating. I assumed that when she could eat, she would. She was a robust eater before her illness, so I thought that would help. Before we left for home, she asked for a hospital pizza (yuck!) and ate a few bites. Her eating at home quickly went back to normal, although it took some time to regain the weight she lost.
In most cases, TPN is started in the hospital. Each day the concentrations of glucose, protein, and fat will be increased in a step-wise fashion, and your child will be assessed for tolerance to the preparation. The time of the total infusion will be consolidated so that administration at home will be feasible. Generally, TPN is given 8 to 12 hours per day, depending on your childs unique situation. The infusion may be delivered over the hours that work best for your family. If your child attends school, overnight infusions will probably work best. If your child is at home during the day, infusions during these hours will give the entire family a better nights sleep.
Be sure to request a small portable infusion pump and backpack from your home care company so that the days activities will not be limited by this therapy. Your childs oncologist may need to write a letter to your insurance company to verify your childs malnutrition so that this therapy is covered.
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