TOTAL PARENTERAL NUTRITION

Surgical patients often present with conditions that have eitherimpaired ability to maintain their nutrition before operation or have made it impossible for them to obtain optimalnourishment by conventional means after surgical intervention. As rationing of the health care services became anincreasing reality, the pressure to justify intervention such as nutrition support was intensified. The study was designedto see the indications, management and anticipated complications of total parentral nutrition in adult surgical patients.Design: Retrospective controlled study. Place and Duration of Study: During August 1997 to August 1998 at surgicaldepartment Pakistan Naval Ship (PNS) Hospital Shifa Karachi. Material and Methods: 30 indoor patients wereselected. They were divided into three groups according to the pathological entities. After assessing nutritional status,providing emergency treatment of relative pathology and calculating calories, central line was maintained byapproaching subclavian (76.6%), femoral or antecubital vein. TPN was monitored, clinically and with laboratoryinvestigations. Results: The group-I lagged approximately three days behind the others in achieving goal calories.Weight gain in most of the patients was significant after two weeks. Initially all three groups showed hyperglycemia,which was tapered by regular insulin over a Period of 3 to 3.5 days and rescheduling the nutrient substrates. Albumindid not change significantly. Catheter sepsis was evident in third group. Conclusion: It was concluded that Judicioususe of TPN by thoughtful and conscientious nutritionist surgeons in surgical patients decreased morbidity/mortality rate,improved quality of life, with smooth recovery, convalescence and rehabilitation, decreased hospital stay andacceptable cost: benefit ratio.