Skip to content

The Role of TPN in Crohn’s Disease and Ulcerative Colitis: What is it and Why is it Used?

Have you ever heard someone who has Crohn’s disease or ulcerative colitis mention that they are on TPN but don’t know that means? Today’s post is all about the role TPN plays in Inflammatory Bowel Disease. I have been on TPN many times so I will include some of my personal experience in this to compliment the information. So what is TPN? 

What Is TPN?

Total Parenteral Nutrition

‘Parenteral’ means to eat (-enteral) through an IV (par-). 

TPN, or Total Parenteral (pronounced pah-wren-tur-ull) Nutrition, in the simplest way to describe it is to receive nutrition through your veins and into the bloodstream. To go more in-depth, it is used to feed a person intravenously to bypass the normal process of eating and digestion. Basically you won’t be eating by mouth and food will not be traveling through your digestive tract. You’ll be “eating” through your veins. Unless you are on PPN (Partial Parenteral Nutrition) and then you can eat by mouth in addition to receiving intravenous nutrition. But we will get to that in a bit! 

To receive TPN a patient will need to have a central line placed because the solution is very concentrated and can cause thrombosis to peripheral veins. A pharmacist who has special training to make parenteral nutrition will make the solution specifically for you based off of your blood work, weight, health conditions, and other factors. The TPN solution will contain all of the calories and nutrients you require for the day. 

People can receive TPN at the hospital or at home. If you are in the hospital the bag of TPN will be hung from an IV pole and an IV pump will pump the solution into your veins through IV tubing.  If you are at home with TPN you can put everything in a backpack so you can take it everywhere you go and not have to be connected to an IV pole the entire time. One bag of TPN supplies the calories and nutrients you need for 24 hours. You start another bag of TPN 24 hours after the previous bag. You will need 7 bags per week unless your medical team decides otherwise. 

Typically people only need TPN for a short period of time but some people need it long term. Some people can eat food while they are on TPN and others cannot eat anything by mouth and must rely on the TPN completely. The reason the person is put on TPN and the goals for it’s use determine whether or not it is possible to eat in addition to being on TPN. 

TPN Fast Facts

  • TPN is known as intravenous feeding because you are receiving nutrition through your veins where it is absorbed into the bloodstream.
  • The TPN solution comes mixed in a bag and is usually hung from an IV pole. A pump pushes the solution through IV tubing and into the bloodstream. Sometimes patients wear special backpacks to put their TPN and pump in because it allows them be more mobile.
  • TPN requires the patient to have a Central Venous Catheter (CVC) because the solution is very concentrated. Usually a PICC line or a tunneled catheter in the chest is used.
  • TPN is specially formulated for the patient and provides all of the daily nutrients and calories that the patient requires.
  • TPN stands for: Total = all. Parenteral = to take into the body other than through the digestive tract. Nutrition = the process of nourishment. So Total Parenteral Nutrition means receiving all (total) of your nutrients (nutrition) intravenously (parenteral).
  • Some patients being fed this way are just using the parenteral nutrition to supplement what they are already eating; usually to help them gain weight or if they have Short Bowel Syndrome. This can be particularly useful for pediatric IBD patients who need proper nutrition for growth and development. If the person is still eating some of their nutrients by mouth then they are not receiving all (total) of their nutrients parenterally. Rather they are receiving nutrients partially through intravenous feeding. Therefore they are on PPN (Partial Parenteral Nutrition) and not TPN (Total Parenteral Nutriton).
  • People can receive TPN in the hospital or at home. If they are at home with TPN they will have a home care nurse and an infusion company as part of their care team. Some of the things home care helps with is educating the patient and their family, train them to administer TPN themselves, draw blood for lab work, change central line dressings, and make and ship TPN and medical supplies.
  • Some people use TPN for just a few weeks to a few months and some use it more long-term. In rare cases some patients may have to be on TPN for the rest of their lives. An example of long-term TPN for IBD would be a person with Crohn’s disease who has had many surgeries to remove portions of the bowel and now has short bowel syndrome and cannot absorb enough nutrients from eating or tube feeding.
  • TPN solutions contain dextrose, proteins, fats, electrolytes, trace minerals, and vitamins.
  • TPN can save lives.

Why is TPN used for IBD?

Diagram of how TPN works showing where a PICC line enters my body and where it lays above the heart along with how the pump and IV bag work
BEHIND THAT CURTAIN WAS A ROOMMATE FROM HELL
  • Bowel obstruction – stricture, volvulus, adhesions, etc. 
  • Temporary ileus after abdominal surgery. 
  • Nutritional depletion.
  • The small bowel can’t absorb nutrients properly. 
  • The patient needs to “rest” the bowel by not having any food pass through them in order to help it heal. 
  • The patient is having a difficult time eating enough food after surgery or during a flare. 
  • Severe weight loss. 
  • Short bowel syndrome – usually caused by multiple resection surgeries.
  • Prolonged diarrhea.
  •  High output fistula. 
  • Get a patient in better health in preparation for surgery.
  • To supply nutrients required to help a patient heal after surgery.

Benefits & Risks/Disadvantages of TPN

Benefits

  • Help patient return to a healthy weight.
  • Nutritional repletion while resting the bowel.
  • May aid in healing the bowel.
  • Could provide less diarrhea and abdominal pain.
  • Can help get a patient into better condition before surgery for better chance of positive outcomes / reduce risk of complications.
  • Nutritional support after surgery to aid in healing.
  • Patient feels better and has more energy with proper nutrition.
  • For children nutrition is extremely important for growth and development. TPN can be a help in this area.

RISKS

  • Catheter sepsis.
  • Very costly.
  • Bone disease.
  • Liver disease or damage.
  • Hyperglycemia or hypoglycemia.
  • Refeeding syndrome.
  • Kidney disease.
  • Volume overload.
  • Fluid and electrolyte complications.

Even though TPN has a lot of benefits it should only be used when absolutely necessary as it comes with some serious risks. Every attempt to use the alimentary tract first should be made unless unwise to do so. Some of these risks may seem like no big deal but many can be life threatening. It is important to work with your medical team while you are on TPN to reduce these risks.

I hope this has helped explain what TPN is and why it might be used for someone who has Crohn’s disease or ulcerative colitis. 

Looking in the mirror with my IV pole next to me and on it hangs TPN.
Standing in my bathroom running TPN

Sara

Share on pinterest
Share on twitter
Share on facebook
Share on google
Share on linkedin
Share on email
Click the image to the left to save to Pinterest
Like this post and want to reference it later? Click the image to the left. You can also check out my award winning Pinterest boards by clicking the button below.