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Parenteral nutrition

Key sources
The following summarized guidelines for the evaluation and management of parenteral nutrition are prepared by our editorial team based on guidelines from the American Society for Parenteral and Enteral Nutrition (ASPEN 2014).
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Guidelines

1.Diagnostic investigations

Clinical assessment: assess clinical factors derived from history, physical examination, and diagnostic evaluations in determining if enteral nutrition is contraindicated.
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2.Medical management

Nutrition formulation: we suggest that parenteral nutrition with an osmolarity up to 900 mOsm/L can be safely infused peripherally. Higher osmolarity limits, especially when peripheral parenteral nutrition is prepared as a total nutrient admixture, may also be tolerated, but the evidence to support a safe limit is lacking.
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More topics in this section

  • Parenteral nutrition formulations

  • Non-nutrient medication mixture

  • Fat emulsions (patients with TPN liver disease)

  • UDCA (patients with TPN liver disease)

  • Indications

  • Contraindications

  • Timing of care in adults

  • Timing of care in pediatric patients

  • Complications

  • Monitoring of treatment response

  • Appropriateness of parenteral nutrition use

3.Nonpharmacologic interventions

Repackaging of IV fat emulsions: avoid repackaging intravenous fat emulsions into syringes for administration to patients. Prefer other methodologies for repackaged intravenous fat emulsions, such as drawn-down intravenous fat emulsions units.
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4.Therapeutic procedures

Vascular access device, VAD insertion: tailor the selection of vascular access device for parenteral nutrition administration based on an evaluation of the risks and benefits of the device, clinical factors, and psychosocial considerations.
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5.Specific circumstances

Pediatric patients: consider parenteral nutrition for neonates in the critical care setting, regardless of diagnosis, when enteral nutrition is unable to meet energy requirements for energy expenditure and growth.
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More topics in this section

  • Peripheral parental nutrition

  • Intradialytic parenteral nutrition

  • Perioperative parenteral nutrition

  • Palliative care patients

  • Home parenteral nutrition

6.Patient education

Health professional education: consider providing education to healthcare professionals to improve parenteral nutrition ordering, thereby reducing errors.
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7.Preventative measures

Ethanol lock for prevention of catheter infection: consider ethanol lock therapy to prevent catheter-related bloodstream infection and to reduce catheter replacements in children at risk of parenteral nutrition-associated liver disease.
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8.Follow-up and surveillance

Indications for specialist referral: consider referring patients with parenteral nutrition-dependent intestinal failure to multidisciplinary intestinal rehabilitation programs.
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