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Sendra theepaavalikku thaan periyammaavin puntaikkul en sunni maththappaa kozhuththipota perum muyarsi seydhu kataisiyil adhu piraivasasi illaamal. Contraindications Treating a patient with TPN when it is not indicated is not only frustrating for the doctor as well as the patient but is also an unnecessary drain on scarce resources.

Definite contraindications to TPN include the following : 1 Where gastrointestinal feeding is possible. Almost always this is the best route to provide nutrition to the patient [ 5 ].

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These should be corrected before attempting intravenous hyperalimentation. Nutritional Assessment While the indication for TPN may be self-evident in the majority of the patients, it is recommended to have some form of assessment of the nutritional status of the patient prior to institution of TPN in order to plan the treatment and to formulate clear-cut therapeutic goals [ 4 ].

Traditional methods include historical, anthropometric, biochemical and immunological parameters. Besides obvious signs of malnutrition, triceps skinfold thickness is the most important part of physical assessment.

Anthropometric assessment in the form of height-weight ratio and total body surface area gives a rather crude assessment. Serum albumin and transferrin levels are readily assessable biochemical parameters and have been extensively used in clinical practice.


Retinol-binding protein and thyroxin-binding globulin also reflect visceral reserves but are rarely available clinically. Total lymphocytic count not only assesses the immunological status but is also reflective of visceral protein reserves.

Immunological status can be further assessed by delayed cutaneous hypersensitivity to PPD and candida antigens. A combination of these factors is highly predictive of outcome in terms of morbidity and mortality or survival.

Nutritional Requirements and Delivery of TPN The delivery of TPN is via a large bore central venous catheter placed in the superior vena cava through the subclavian or the internal jugular vein.

Strict asepsis is to be observed during the placement of the catheter. A chest radiograph should be taken prior to the commencement of feeding to confirm the position of the catheter-tip and to exclude traumatic pneumothorax, the commonest complication related to catheter placement. The catheter should be flushed with dilute heparin daily, to avoid catheter thrombosis.

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