Misconceptions

1. Trios  Parenteral Nutrition does not support the use of TPN on patients with a fully functional GI tract.  The only exception to this rule is if the patient is so malnourished that their albumin or prealbumin are at critical levels and it is believed that the oral route can not address this in a reasonable time frame.
   
2. TPN and candidemia:  We have only seen 2 patients out of 42 patients in the past 18 months that were diagnosed yeast infections.  Both patients had the common factors of suprapubic catheter, infections treated with Vancomycin for 3-4 weeks prior to the yeast infection, history of frequent UTIs, noncompliant diabetic patients, and documented history that the TPN was not the source.
3. Trios Parenteral Nutrition standard of care is twice weekly monitoring of labs initially, and weekly after the patient achieves stability in lab values.  Labs are supervised primarily by our nutritional team with recommendations made to the home health agency and collaborating physician. 
   
4. The average length of therapy for TPN patients depends on their initial clinical presentation, however many patients have achieved significant results within 45-90 days.  We recommend continuing to follow monthly CMP to monitor status and albumin level
   
5. With a custom mix TPN, we are able to adjust caloric intake, fluid balance, electrolyte balance, anion gap, and to some extent the impact on the liver function.  With concentrated macronutrient solutions, we are able to address fluid restrictions in acute renal failure/dialysis patients, and adjust infusion schedules for continuous or cyclic infusions.
   
6. We recommend lipid administration consistent with ASPEN guidelines: no less than 250ml of 20% lipids 3 times a week (107ml/day).  A 3-in-1 admixture reduces the potential for medication errors and infectious risk.
   
7. It has been suggested that the amount of dextrose in the TPN could be adjusted of the metabolic implications lead to increased CO2 levels.  Upon further discussion, the CO2 measurement entails more factors than just dextrose metabolism so this may not be a significant indicator for trach, vent, or Bipap patients.
   
8. Administering pancreatic enzymes to patients with failed fecal fat studies will potentially address digestive issues but not absorption issues as fats and proteins are absorbed by active transport mechanisms – this may be diagnostic and may be appropriate for a research study.