HUMS Hospital

Total Parenteral Nutrition (TPN): Ordering, Preparation & Administration
Total Parenteral Nutrition (TPN), also referred to as Parenteral Nutrition (PN), is the intravenous delivery of essential nutrients to patients who are unable to consume or absorb adequate nutrition through oral or enteral (tube) feeding. TPN formulations typically include:
• Proteins
• Carbohydrates
• Fats
• Electrolytes and minerals
• Vitamins
• Trace elements

TPN is vital for maintaining nutritional status, preventing complications, and supporting patient recovery, especially in cases where gastrointestinal function is severely compromised.

Common clinical indications for TPN include:
• Short bowel syndrome
• Gastrointestinal (GI) fistulas
• Bowel obstruction
• Critical illness
• Severe acute pancreatitis

The preparation and administration of TPN require precise formulation, aseptic technique, and close monitoring to ensure safety, efficacy, and individualized patient care.

Please see: CP's FDS for Clinical Pharmacy
Page 13 - Wireframe for TPN Screening
Page 14 - TPN Preparation Worksheet
Page 15 - TPN Label
Page 16 - MIS Report for TPN Preparations

TPN is not required for PCC

Compounding of Parenteral Nutrition (PN)
Parenteral nutrition (PN) is the administration of essential nutrients, such as, carbohydrates, proteins, fats, vitamins, minerals, and fluids through an intravenous (IV) line. It is indicated when the gastrointestinal tract cannot absorb or process food, either temporarily or permanently.

PN is commonly used following abdominal surgery, during chemotherapy, when bowel rest is required, and in cases of severe malabsorption or profound malnutrition.

Over time, the reliance on in-house compounded PN has shifted toward readily available commercial formulations such as Kabiven, Omegaven, Intralipid, and SMOFlipid. These commercial PN products offer several advantages, including a lower risk of contamination compared to in-house compounding and flexible formulations tailored for adults, paediatric patients, and special clinical conditions (e.g., liver complications).

Please note that the sub-tasks for development for PN will be exactly the same as for Extemporaneous Preparation - encompassing the steps of 1. Screening of the prescription, 2. Assignment of Screened Parenteral Nutrition order to Workbench or Workstation, 3.Preparation (Compounding of Parenteral Nutrition Solution (PN Formulation)), 4.Printing of Medication Label & Compounding of PN formulation.

Workflow for PN Formulation Compounding
1. The doctor orders parenteral nutrition via CliniCare.
2. The pharmacist receives the order (via the Pharmacy Module).
3. The pharmacist screens and verifies the order for completeness and appropriateness based on patient-specific criteria as well as established treatment protocol and clinical practice guidelines (CPGs)
4. The pharmacist calls up the doctor and discusses the order with him/her if there are discrepancies or when clarification is required.
5. The pharmacist generates the relevant worksheet & label.
6. The pharmacist checks the printed label against worksheet to ensure that the details in the label are correct.
7. The pharmacist prepares required components for the required order.
8. The pharmacist counterchecks the components to see that they are correct.
9. The pharmacist prepares the requested PN formulation (compounding). The requested PN formulation is prepared in a sterile room under strict aseptic technique.
10. The pharmacist checks the prepared PN formulation against worksheet to ensure that it is correct.
11. The pharmacist sticks the printed label onto the prepared PN formulation.
12. The pharmacist releases the prepared PN formulation to the requesting unit.
13. The pharmacist records the task and documents any associated findings.
14. END.