Imagine that you or someone you know has had to undergo major intestinal surgery. Or that you have a severe intestinal disorder that has left you unable to eat or drink anything by mouth. How do you provide the body with the nutrition and energy it needs? That is when we use this special method called 'intravenous nutrition'. This is something very different and complex than the usual saline solution. Let's take a look at the details.
What is parenteral nutrition?
Although the name sounds a bit strange, the meaning is very simple. The word "parenteral" means "outside the digestive system." That is, Parenteral Nutrition is when the food we eat through our mouths goes into the stomach, is absorbed by the intestines, and is changed in the liver before being absorbed into the body. It is called Parenteral Nutrition , and all the nutrients the body needs are given directly into a blood vessel.
Simply put, this is bypassing our entire intestinal system, starting from the mouth and ending at the anus, and delivering all nutrients directly into a blood vessel.
Some people may only need to take this for a few days, while others may need to take it for weeks, months, or even a lifetime.
What are the main types of this method?
This can be classified in two main ways. One is based on the amount of nutrition given, and the other is based on the vein that provides the nutrition.
| Classification according to the amount of nutrition provided | |
|---|---|
| Type | Simply put... |
| Total Parenteral Nutrition (TPN) | This is given to those who cannot use their intestinal system at all . It provides 100 percent of the nutrition the body needs. |
| Partial Parenteral Nutrition (PPN) | This is given to those who can eat a little by mouth, but it is not enough for the body, and to those who are malnourished. This is given as additional nutrition. |
| Classification according to the feeding vein | |
| Central Parenteral Nutrition (CPN) | This is given into a large vein in the neck or chest that goes directly to the heart. This allows for more calories and more concentrated nutrition. This is the method used to give TPN. |
| Peripheral Parenteral Nutrition (PPN) | This is given into a small vein in the arm, leg, or neck. It is used to provide short-term, partial nutrition (PPN). It is easy to administer, but it does not provide a high amount of calories. |
What does this nutritional liquid contain?
This is not just a bottle of saline. This is like a nutritional 'cocktail' specially made for the patient. This liquid is made by calculating exactly what your body needs, taking into account many factors such as your age, weight, medical condition, and blood reports.
These mainly include:
- Water
- Carbohydrates (for energy)
- Proteins (for body growth and cell repair)
- Fats/Lipids (for more energy)
- Vitamins
- Mineral salts (Electrolytes)
This solution is so complete that a person could live on this alone for a lifetime without eating anything by mouth.
In what cases is intravenous nutrition given?
This is only used in extreme cases when the patient cannot be fed in any other way.
Situations where total parenteral nutrition (TPN) is needed
- After surgery to remove a large portion of the intestine
- Severe side effects of chemotherapy for cancer
- Intestinal obstruction
- Reduced blood flow to the intestines (Intestinal ischemia)
- Inflammatory bowel diseases, such as severe Crohn's disease
- Babies born very prematurely and with underdeveloped intestines
- Severe, prolonged diarrhea
- Other serious medical conditions that require complete rest for the intestinal system
Situations where partial nutrition (PPN) is required
PPN is usually given to provide extra strength to patients who are malnourished due to prolonged hospital stays and insufficient oral intake.
Catheter insertion and treatment
This is not just a cannula that you put in your hand. This requires a special tube called a catheter to be inserted into a large vein in your body. This is like a minor operation. But don't worry, you will be anesthetized (numb) and this is done. The doctor will clean your skin and insert the catheter directly into the vein with the help of ultrasound or X-ray.
There are three main types of catheters:
- External “tunneled” catheter: This is a tube that is inserted under the skin for a short distance and then exits at a different location.
- Fully implanted catheter: This is completely hidden under the skin. There is only a small port under the skin through which the medication is injected.
- PICC line: This is a tube that is inserted through a vein in the upper arm and runs into a large vein in the chest. It is used for short-term treatment (less than 6 weeks).
This nutrient solution takes about 10-12 hours to reach the body. Therefore, many people apply it at night while they sleep. This treatment can be done in the hospital, or at home with the necessary training. However, these things need to be managed very cleanly to avoid infection .
What are the possible risks and complications?
Although this procedure is life-saving, it can carry some risks and complications. That's why doctors only use it in extreme cases and continue to monitor the patient.
| Complication | Simple explanation |
|---|---|
| Infection | Bacteria can enter the bloodstream through the catheter. This can spread and cause a life-threatening condition called sepsis . This is the main and most serious risk . |
| Blood Clots | Blood clots can form where the catheter connects to the vein. |
| Liver problems | Taking TPN for a long time can cause damage to the liver. This is also called Parenteral nutrition-associated liver disease (PNALD). |
| Blood sugar imbalance | Sugar levels can suddenly increase (Hyperglycemia) or decrease (Hypoglycemia). This is controlled by administering insulin. |
| Thinning of bones | Over the long term, changes in things like calcium and vitamin D can lead to weak bones (Osteoporosis). |
| Gallbladder problems | Because the digestive system is not working properly, bile in the gallbladder can accumulate and form stones. |
How do you get used to eating by mouth again?
Once the intestinal system starts working again, doctors try to get the patient back on oral feeding as quickly as possible, because the intestines can become "lazy" if they are not used regularly.
This is done very well.
They don't start eating rice right away. They start with a 'clear liquid diet'. For example, things like boiled water, salted porridge, and water. If the body can tolerate it, then they move on to a full liquid diet. Only then are they introduced to solid foods.
Throughout this time, the medical team is closely monitoring your body's nutritional levels.
Take-Home Message
- Parenteral nutrition is a very important life-saving treatment for those who cannot eat by mouth.
- In this, all the nutrients the body needs are delivered directly into a blood vessel.
- There are two main types: TPN (total parenteral nutrition) and PPN (partial parenteral nutrition).
- Because this method carries risks such as infection, blood clots, and liver problems, it is only done under the strict supervision of doctors.
- If you or someone you know has been prescribed this treatment, don't be afraid. Ask your doctor about it and understand it well. Follow his instructions exactly.
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