General Considerations (Parenteral Nutrition)

1. TPN is generally unavailable in a combat zone.

2. Only utilize TPN when enteral nutrition is not possible or is inadequate to meet the minimal estimated caloric requirements.1

3. General initial TPN orders: 20-25 kcals/kg. Initial Dextrose of 150 g if diabetic, 200 g if not diabetic. Increase by 50 g/day if good glycemic control. Glucose infusion rate of 2-3 mg/kg/min initially. IV-Lipids of no more than 1 g/kg/d. Hold IV lipids if TG > 400 mg/dL. Provide trace elements only 1-2x/wk if total bilirubin is > 4 mg/dL.

4. Ensure patient has a clean, dedicated central line or peripherally-inserted central catheter (PICC) for administration of TPN.

5. A 0.2 micron in-line filter should be used with non-lipid containing TPN, and a 1.2 micron filter used with any lipid-containing TPN.