Total Parenteral Nutrition in Crohn's Disease

Indications for TPN

The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines indicate that TPN is necessary for patients with malnourishment or risk of malnourishment, inadequate or unsafe oral intake, and non-functioning or perforated gut, including those with obstructed gut due to Crohn's disease 1
The American Gastroenterological Association (AGA) recommends parenteral nutrition for patients with Inflammatory Bowel Disease (IBD) with severe malnutrition when oral and enteral nutrition has been trialed and failed 2

ESPEN guidelines note that perioperative use of TPN in Crohn's disease follows similar indications as other surgical procedures, including recent stricturoplasty surgery 1

The AGA notes that whenever possible, enteral nutrition (EN) is the preferred route of nutrition over parenteral nutrition (PN) 2
Once bowel function improves, gradually transition to enteral nutrition, considering a combination of parenteral and enteral nutrition during the transition phase 2

Monitor for central line-associated bloodstream infections, and implement strict aseptic technique for line management, avoiding the use of the feeding line for medication administration 3
Patients with Crohn's disease may have a higher incidence of catheter-related bloodstream infection and venous thrombosis, and should be monitored for electrolyte abnormalities and hyperglycemia 3