Definition and indications for parenteral nutrition in adults
Parenteral nutrition support refers to the intravenous infusion of a nutrition formula. Total parenteral nutrition means that the infusion is providing the patient’s complete nutritional requirements.
Parenteral nutrition is a complex form of nutrition support. Ideally, it should be managed by a nutrition support team that includes medical, dietetic, nursing and pharmacy staff. Management by a multidisciplinary team is more cost effective and efficient, and may be associated with a reduction in infectious complications and more appropriate use of parenteral nutrition.
Parenteral nutrition should only be considered when it is not possible to meet the patient’s nutritional requirements by the enteral or oral route. This is usually due to an inability to gain access to a functional gastrointestinal tract, or intestinal failure.
Patients should be referred to a tertiary hospital with an intestinal failure service for consideration of home parenteral nutrition, if they have:
- prolonged intestinal failure that is unlikely to resolve in the short term
- extensive intestinal resection resulting in short bowel syndrome
- extensive mucosal disease affecting absorption of enteral nutrition (eg radiation enteritis, Crohn disease)
- motility disorders (eg chronic intestinal pseudo-obstruction)
- intestinal fistulae
- mechanical bowel obstruction.
Short-term parenteral nutrition may be required:
- for patients with acute intestinal failure (eg postoperative ileus)
- to supplement enteral nutrition where nutritional requirements are not being achieved
- for patients with a mechanical bowel obstruction
- if there is a lack of enteral access.