• Skip to main content
  • Skip to primary sidebar
  • Health
  • Presentation
  • Procedures
  • Diseases
  • Women
  • Subscribe
  • About
    • Privacy Policy
    • Contact Us

medcaretips.com

Health, Medicine and Medical Care

telegram channel medcaretips
You are here: Home / Health / Parenteral Nutrition Indications and Complications

Parenteral Nutrition Indications and Complications

By Dr Arun Pal Singh

toc
    • Indications
    • Contraindications
    • Parenteral Nutrition Feed preparations
    • Monitoring
    • Complications
    • Home Nutrition

Parenteral nutrition  is the feeding of a person through intravenous route by providing nutritional formulae that contain nutrients.parentral nutrition

Parenteral nutrition could be total or partial. Total parenteral nutrition or total nutrient admixture is when no significant nutrition is obtained by other routes [entral].

Partial  parenteral nutrition is used when  nutrition is also partially enteric.

Depending on the access, the nutrition may be called peripheral parenteral nutrition when administered through vein access in a limb or central venous nutrition when administered through central vein.

Parenteral nutrition is used in less than 4—5 per cent of all hospital admissions.

It is used either when enteral feeding is not possible, or to supplement deficient enteral feeding.

Parenteral nutrition is not without the risks and is used in cases when the benefits outweighs the risks.

Displacement of the catheter, sepsis, mechanical problems and metabolic derangements  are the common complications of the parenteral nutrition.

Indications

Parenteral nutrition is indicated for all patients who are either  malnourished or at risk of malnutrition and cannot be fed entrally.

Enteral feeding is preferred over parenteral feeding in inpatients with functioning gastrointenstinal tracts.

Parenteral nutrition can be considered in following situations

  • Gastrointestinal disorders
    • Bowel obstruction
    • Short bowel syndrome
    • Gastroschisis,
    • Prolonged diarrhea regardless of its cause
    • High-output fistula
    • Very severe Crohn’s disease
    • Ulcerative colitis
    • Congenital GI anomalies
    • Necrotizing enterocolitis
  • Perioperative nutritional support
  • Patients with high risk of prolonged postoperative ileus
  • Pancreatitis and pancreatic fistulae
  • Palliative surgical and non-surgical oncology

Contraindications

  • Cardiac failure
  • Severe liver disease
  • Disorders of fat metabolism
  • Uncontrolled diabetes
  • Shock
  • Severe blood dyscrasias
  • Inexperienced hands.

Parenteral Nutrition Feed preparations

Nutritional requirements  are calculated for the patient depending on his/her requirement of carbohydrate, fat, protein, vitamins, minerals and trace.

Solution for total parenteral nutrition contain a balanced mix of essential and non-essential amino acids, glucose, fat, electrolytes and micronutrients:

Parenteral nutrition should be introduced at a low rate and gradually increased.

Parenteral nutrition can either be given at a continuous rate or in cyclical regimen.

Vitamins including folic acid are infused with the solution, but vitamin B12 must be prescribed separately.

Solutions for total parenteral nutrition may be customized to individual patient requirements, or standardized solutions may be used.

Monitoring

Patients on parenteral nutrition should be monitored. It involves observations and laboratory investigations.

Apart from vital sign monitoring and other clinical signs, the patient should be daily monitored for signs of inflammation or infection at the site for catheter. Signs of thrombophlebitis may be looked for.

Patient should be periodically investigated for. The frequency depends on the condition of the patient.

  • Complete blood count daily
  • Vitamin B12 levels
  • Folate levels
  • Magnesium, phosphate and calcium levels every 3 months
  • Zinc, iron, selenium and copper levels – every 2-4 weeks.
  • Blood glucose levels every 4-6 hours
  • Liver function tests twice weekly
  • Serum protein levels twice weekly
  • Inflammatory markers – ESR and  C-reactive protein

The frequency of most tests can be reduced once the patient’s condition is stable.

Complications

  • Infection of catheter
    • Most frequent
    • Septic shock can occur
    • Common cause of death
  • Blood clots and  pulmonary embolism
    • Thrombolytic flush can help
  • Fatty liver and liver failure
  • Hungermpangs
    • Failure of satiation as patient does not eat
  • Hepatobiliary Dysfunction
    • Cholecystitis
    • Chlestasis
    • Cholelithiasis
  • Gut atrophy in infants
  • Catheter complications
    • Pneumothorax
    • Accidental arterial puncture
    • Catheter-related sepsis.
  • Metabolic complications
    • Hypokalemia- decrease in potassium levels
    • Hypophosphatemia – decrease in phosphate levels
    • Hypomagnesemia – decrease in magnesium levels
  • Hyperglycemia -High levels of glucose
  • Hypoglycaemia  -Low levels of glucose
  • Refeeding syndrome
    • Starvation depletes intracellular  phosphate.
    • Feeding stimulates the cellular uptake.
    • Results in electrolyte imbalance.
    • Rhabdomyolysis, cardiac failure, hypotension, arrhythmias, respiratory failure, seizures and coma can occur.

Home Nutrition

Chronic intestinal failure results in a failure of adequate nutrient absorption from the gut to maintain body weight. This may follow extensive bowel resection, multiple high output fistulas, motility disorders and extensive Crohn’s disease. Such patients require prolonged nutritional supplementation at home parenteral nutrition.

Patients must receive training and information on nutrition prior to discharge.

Patient should be  confident in the management of feeding systems and aware of common issues.

There must be a fall back option where patient can ask for help.

 

Spread the Knowledge
5     
5
Shares
5    

Filed Under: Health

Primary Sidebar

Subscribe to updates

Receive articles in your inbox !!
Enter your email address below

nash or nonalcoholic steatohepatitis

NASH or Nonalcoholic steatohepatitis

Nonalcoholic steatohepatitis (NASH) is inflammation and damage of the … [Read More...] about NASH or Nonalcoholic steatohepatitis

Autoimmune hepatitis

Autoimmune Hepatitis: Clinical features, Diagnosis And Treatment

Autoimmune hepatitis is a disease in which the immune system of the … [Read More...] about Autoimmune Hepatitis: Clinical features, Diagnosis And Treatment

Pruritus or Itching

Itching or Pruritus : Causes, Diagnosis, and Treatment

Itching is an unpleasant sensation of the skin that leads to a desire … [Read More...] about Itching or Pruritus : Causes, Diagnosis, and Treatment

Pain

Pain-Classification, Diagnosis and Treatment

Pain is an unpleasant and uncomfortable sensation caused by injury or … [Read More...] about Pain-Classification, Diagnosis and Treatment

acne care-dos and don'ts

10 Dos and Don’ts About Acne Care

Acne (pimples) is a common, self-limiting skin condition that affects … [Read More...] about 10 Dos and Don’ts About Acne Care

Copyright © 2022 Med Care Tips

Manage Cookie Consent
This website uses cookies. Please accept cookies for a better visiting experience
Functional Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Manage options Manage services Manage vendors Read more about these purposes
View preferences
{title} {title} {title}