Parenteral Nutrition

Total parenteral nutrition (TPN) therapy provides intravenous nutritional support for patients who cannot ingest food. A patient who suffers from a poorly functioning gastrointestinal tract or whose disease state requires bowel rest benefits greatly from this therapy. TPN therapy provides a source of protein, carbohydrates, fats, minerals and vitamins to provide optimal nutrition to ensure healing and wellness.

Whether adult or child, formulations can be modified to provide for each patient’s individual fluid, electrolyte and caloric needs. We work closely with each patient’s doctor and dietician to meet their nutritional goals.

Disease states that may require TPN therapy include:

• Pancreatitis
• Crohn’s disease or ulcerative colitis
• Bowel obstruction
• Short bowel syndrome

Please contact a Carmichael’s representative to discuss any TPN therapy needs, to request additional information or to check your insurance or other available coverage.

Intradialytic Parenteral Nutrition (IDPN) therapy is a valuable source of protein and calories for chronic hemodialysis patients who, despite aggressive oral supplementation, still develop decreased albumin levels, weight loss and muscle loss.

Malnutrition is of great concern in dialysis patients because of its association with morbidity, increased hospitalization and mortality. Studies have documented that 20%-60% of chronic hemodialysis patients are malnourished. Low serum albumin levels are one of the strongest predictors of survival in both peritoneal and hemodialysis patients. Improving nutritional intake in this population typically has been difficult or unsuccessful. Even after correcting anemia and inadequate dialysis, many patients remained malnourished. Studies have suggested that patients on dialysis and patients with albumin levels less than 3.4 have benefited from the addition of IDPN therapy.

Services – Our clinical team of pharmacists, technicians and nurses can derive individual formulation to provide for each patient’s individual nutritional needs and the following:

• Direct delivery to the dialysis unit in an efficient and timely manner;
• Intravenous (IV) pumps, poles and tubing for administration;
• Refrigeration for proper storage of IDPN, upon request; and,
• 24 hours a day on-call services.

Benefits:

• Improvement in patient’s appetite, strength and overall well-being;
• Replacement of nutrients lost during the dialysis process;
• Increase in dry body weight;
• Increase in serum albumin levels;
• Decrease in overall hospitalization rates; and,
• Improvement in wound healing outcomes.

Criteria for Initiating IDPN Therapy (Oral supplementation should be attempted prior to initiating IV nutritional support):

• Albumin levels less than or equal to 3.4 gm/dL; or
• Prealbumin levels less than 15 mg/dL; or
• Serum creatinine less than 8mg/dL; or
• Weight loss greater than 10% of estimated ideal body weight or greater than 20% of usual body weight; or
• Dietary history of decreased intake of protein less than 0.8gm/kg/day or caloric intake of less than 25kcal/kg/day; or,
• Clinical examination results consistent with a diagnosis of moderate to severe malnutrition.

Please contact a Carmichael’s representative to discuss any IDPN therapy needs, to request additional information or to check your insurance or other available coverage. Many private insurance companies will approve IDPN therapy with sufficient documentation indicating level of need from their clinician. Medicare patients who have permanent impairment of their gastrointestinal tract may qualify for IDPN therapy.