Determining if a Patient can Wean from TPN

Consider weaning of TPN in adults in the following situations: (1)

  1. Jejunostomy (no colon continuity) >100 cm small bowel

  2. Jejunocolonic (some part of colon) >60 cm small bowel

  3. Jejunoileal (full colonic continuity) >35 cm small bowel

The probability of weaning from total parenteral nutrition (TPN) becomes less than ten percent if weaning is not obtained in the first four years in children and first two years in adults. (2) The goal to be reached for each patient is the minimum required level of parenteral nutrition dependence. It is also important to try and discourage complete parenteral nutrition and encourage some enteral feeding in order to reduce the occurrence of metabolic complications and liver failure.


When managing TPN in an intestinal failure patient it is best to do so with a multidisciplinary nutritional support team that can develop a comprehensive nutritional plan of care that will meet the needs of the patient and caregiver.


References:

1. Langnas AN, Goulet O, Quigley EMM, Tappenden KA. Intestinal Failure Diagnosis, Management, and Transplantation. Malden, MA: Blackwell; 2008.

2. Tappenden KA. Pathophysiology of Short Bowel Syndrome. Journal of Parenteral and Enteral Nutrition. 2014;38(1_suppl). doi:10.1177/0148607113520005.