Why parenteral nutrition

Malnutrition also includes overnutrition. Undernutrition can result from inadequate ingestion of nutrients, malabsorption, impaired metabolism, loss Complications include cardiovascular disorders particularly in people with excess abdominal fat , diabetes mellitus If blind percutaneous placement Catheter-related sepsis rates have decreased since the introduction of guidelines that emphasize sterile techniques for catheter insertion and skin care around the insertion site.

The increasing use of dedicated teams of physicians and nurses who specialize in various procedures including catheter insertion also has accounted for a decrease in catheter-related infection rates. Glucose abnormalities are common. Hyperglycemia can be avoided by monitoring plasma glucose often, adjusting the insulin dose in the TPN solution, and giving subcutaneous insulin as needed.

Hypoglycemia can be precipitated by suddenly stopping constant concentrated dextrose infusions. Treatment depends on the degree of hypoglycemia. Hepatic complications include liver dysfunction, painful hepatomegaly, and hyperammonemia.

They can develop at any age but are most common among infants, particularly premature ones whose liver is immature.

Liver dysfunction may be transient, evidenced by increased transaminases, bilirubin, and alkaline phosphatase; it commonly occurs when TPN is started. Delayed or persistent elevations may result from excess amino acids.

Pathogenesis is unknown, but cholestasis and inflammation may contribute. Progressive fibrosis occasionally develops. Reducing protein delivery may help. Painful hepatomegaly suggests fat accumulation; carbohydrate delivery should be reduced.

Hyperammonemia can develop in infants, causing lethargy, twitching, and generalized seizures. Arginine supplementation at 0. If infants develop any hepatic complication, limiting amino acids to 1. Abnormalities of serum electrolytes and minerals should be corrected by modifying subsequent infusions or, if correction is urgently required, by beginning appropriate peripheral vein infusions.

Vitamin and mineral deficiencies are rare when solutions are given correctly. The mechanism is unknown. Advanced disease can cause severe periarticular, lower-extremity, and back pain. Temporary hyperlipidemia may occur, particularly in patients with kidney or liver failure; treatment is usually not required. Delayed adverse reactions to lipid emulsions include hepatomegaly, mild elevation of liver enzymes, splenomegaly, thrombocytopenia, leukopenia, and, especially in premature infants with respiratory distress syndrome, pulmonary function abnormalities.

Temporarily or permanently slowing or stopping lipid emulsion infusion may prevent or minimize these adverse reactions. Gallbladder complications include cholelithiasis, gallbladder sludge, and cholecystitis. These complications can be caused or worsened by prolonged gallbladder stasis. Oral or enteral intake also helps. Treatment with metronidazole , ursodeoxycholic acid, phenobarbital , or cholecystokinin helps some patients with cholestasis. Consider parenteral nutrition for patients who do not have a functioning gastrointestinal tract or who have disorders requiring complete bowel rest.

Long-term complications may include too much or too little of trace elements, such as iron or zinc, and the development of liver disease. Careful monitoring of your parenteral nutrition formula can help prevent or treat these complications.

Parenteral nutrition is delivered through a thin, flexible tube catheter that has been inserted into a vein. Doctors with special training in nutrition work with you to determine the type of catheter that's best for you. The two main catheter options for delivering parenteral nutrition are:. The catheter placement procedure is usually done after you've received heavy sedation or anesthesia.

The catheter will be inserted into a large vein leading to the heart. Parenteral nutrition through this large vein can deliver nutrients quickly and lower the risk of catheter infection. Your team will use laboratory testing to monitor your responses to parenteral nutrition.

They will also periodically evaluate your fluid balance, the catheter site, and your ability to switch to tube feeding or normal oral feeding. You will have follow-up exams to assess your parenteral nutrition plan. Depending on your reason for using parenteral nutrition, at some point your care team may help you decrease the amount you need.

In some cases, your team will help wean you off it entirely. Specially trained health care providers show you and your caregivers how to prepare, administer and monitor parenteral nutrition at home.

Your feeding cycle is usually adjusted so that parenteral nutrition infuses overnight, freeing you from the pump during the day. Some people report a quality of life on parenteral nutrition similar to that of receiving dialysis. Fatigue is common in people receiving home parenteral nutrition. Total parenteral nutrition care at Mayo Clinic. Lines should be dedicated to feeding and must not be used for drug administration or blood sampling:.

The most appropriate site for central venous access will take into account factors such as the patient's conditions and the relative risk of infective and non-infective complications associated with each site.

Ultrasound-guided venepuncture is strongly recommended for access to all central veins. TPN solutions contain a balanced mix of essential and non-essential amino acids, glucose, fat, electrolytes and micronutrients:.

A wide selection of preparations are produced under sterile conditions and are available as 3-litre bags of prepackaged solution. Parenteral nutrition should be introduced at a low rate and gradually increased: [ 1 ].

During starvation, intracellular electrolyte stores, particularly phosphate, are depleted despite normal serum concentrations. Feeding stimulates the cellular uptake of electrolytes and can lead to electrolyte disturbances with profound hypophosphataemia. Clinical features usually develop within four days of re-feeding, but are often nonspecific. Later manifestations include rhabdomyolysis, cardiac failure, hypotension, arrhythmias, respiratory failure, seizures and coma.

See separate article Nutritional Support in Primary Care. Tight glycaemic control is important in sick patients and so treatment with oral hypoglycaemic agents or insulin is often required.

Monitoring should include the general observations and laboratory schedule recommended for all forms of nutritional support. The frequency of most tests can be reduced once the patient's condition is stable.

In addition there should be daily attention to:. Demand for home parenteral nutrition HPN - to facilitate hospital discharge - is rising, but access to local services may be limited. They are the only units to receive specific funding for this role, and are now oversubscribed. Patients must receive training and information on HPN prior to discharge.

An individual nutritional care plan is drawn up which includes feeding regimens and the required multidisciplinary input.