Summary
Total parenteral nutrition (TPN, also known as PN) is a method of providing nutrition directly into the bloodstream to those unable to absorb nutrients from the food they eat. TPN is used in all age groups, but in babies its use is often as part of a temporary planned programme of nutrition to supplement milk feeds in those too immature to suckle or too sick to receive milk feeds as a result of intestinal conditions.
TPN consists of both aqueous and lipid components, which are infused separately into the baby via specific administration sets and infusion pumps. The rate at which TPN is administered to a baby is crucial: if infused too fast there is a risk of fluid overload, potentially leading to coagulopathy, liver damage and impaired pulmonary function as a result of fat overload syndrome. In a recent three and a half year period 10 incidents were identified where infusion of the aqueous and/or lipid component of TPN at the incorrect rate resulted in severe harm to babies through pulmonary collapse, intraventricular haemorrhage or organ damage, and where intensive intervention and treatment were needed. Most of these incidents involved too rapid a rate of infusion.
Actions
Who: All organisations providing NHS funded-care to neonates and children (especially those under 30 kg) and where TPN is administered.
When: To commence immediately and be completed no later than 8 November 2017.
- Identify if TPN is used in your neonatal and paediatric departments
- Bring this alert to the attention of all those with a leadership role in the prescribing and administration of TPN in neonatal and paediatric settings Consider if immediate action is needed to be taken locally, and ensure that an action plan is underway to reduce the risk of harm to babies through TPN administration.
- Communicate the key messages in this alert, and your organisation’s plan for managing those risks, to all relevant staff.
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