Parenteral Nutrition

A. Indications
· Malnourished Patient—Inadequate intake for > 7 days
Unintentional weight loss > 10% or weight is > 20% below ideal body weight
· Inability to use GI tract—For greater than 7 days
B. Conditions to use Parenteral Nutrition
· Short gut syndrome
· Inflammatory bowel disease
· Fistula >1500 cc output per day
· Obstruction of GI tract
· Acute pancreatitis
· Major gastrointestinal surgery
· Ischemic bowel
C. Contraindications
· Ability to provide adequate energy and nutrients via the enteral or oral route
· Mild or moderate malnourished patient in preoperative period while consuming
· adequate enteral or oral intake
· PPN for > 2 weeks in patients 2nd limited access, osmolality, fluid restrictions, and large
nutrient or electrolyte need
· Unlikely to benefit patients with advanced cancer who have been unresponsive to treatment
D. Advantages
· Provides nutrition when GI tract not functional
· Provides nutrition when access to GI tract not possible
E. Disadvantages
· Risk of infection associated with TPN
· Risk of central line placement
· Metabolic complications
· Sequelae of dormant gut—leads to increased risk for development of infectious complications
F. Guidelines for Use
· Preoperative TPN if patient cannot receive enteral feeds prior to surgery
· Preoperative TPN in severely malnourished surgical patients
· Postoperative TPN when NPO status after surgery for > 5 days with severely
malnourished patients
· Postoperative TPN when NPO status after surgery for >7 days with mild to moderate
malnourished patients