For over 25 years, total parenteral nutrition (TPN) has played a critical role in modern medicine. Initially developed by Dudrick and his team, this life-sustaining therapy has dramatically improved survival rates for patients with intestinal failure, particularly those with short bowel syndrome. Continuous refinements in catheter technology and infusion systems, combined with deeper insights into metabolic requirements, have allowed for customized nutritional formulations tailored to individual patient needs. Today, TPN stands as an essential therapeutic option, with clearly defined clinical applications and a well-documented safety profile. Among them, TPN bags made of EVA material have become the preferred packaging solution for clinical and home nutrition support due to their excellent biocompatibility, chemical stability and long-term storage safety. The shift toward home-based administration has further enhanced its practicality, reducing hospitalization costs while maintaining efficacy. Researchers are now investigating potential new uses for TPN, including its role in managing chronic conditions such as atherosclerosis.
Before initiating TPN, a thorough nutritional assessment is essential to optimize treatment outcomes. Key evaluation components include reviewing the patient's medical history for significant weight loss (10% or more), muscle weakness, and edema. Physical examination should focus on anthropometric measurements, particularly triceps skinfold thickness, which provides valuable insight into fat reserves. Laboratory testing typically involves serum albumin and transferrin levels, widely used markers of protein status, though more specialized tests like retinol-binding protein may offer additional information when available. Immune function can be assessed through total lymphocyte count and delayed hypersensitivity skin testing with common antigens such as PPD or Candida.
A particularly useful predictive tool is the Prognostic Nutritional Index (PNI), which combines several parameters into a single risk score:
PNI(%) = 158 - 16.6(serum albumin in g/dL) - 0.78(triceps skinfold in mm) - 0.20(transferrin in mg/dL) - 5.8(hypersensitivity score).
Patients with a PNI below 40% generally have a low risk of complications, while those scoring 50% or higher face a significantly elevated mortality risk of approximately 33%. This comprehensive assessment approach helps clinicians make informed decisions about when to initiate TPN and how to monitor its effectiveness, ultimately improving patient care in both acute and chronic settings. The integration of advanced nutritional support with rigorous assessment protocols remains a cornerstone of modern medical practice.
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Post time: Aug-04-2025