Assessment for Parenteral Nutrition in Adults


However, when used as the primary feeding modality, either EN or PN is acceptable in the first week of critical illness.14,15


Use of Peripheral Parenteral Nutrition


The ASPEN task force developed the following consensus recommenda- tions regarding the use of peripheral PN (PPN)6


:


ƒ Use PPN only for short-term purposes (no more than 10 to 14 days), as supplemental PN or as a bridge therapy during transition peri-


ods, or when a central venous catheter cannot be placed. ƒ Maintain an upper limit of 900 mOsm/ L for PPN formulations.


Contraindications for use of PPN include significant malnutrition, severe metabolic stress (eg, hypercatabolism), large nutrient or electrolyte needs, fluid restriction, need for prolonged PN (>2 weeks), and renal or liver compromise.14


Other Clinical Situations for Parenteral Nutrition Use


Appropriate PN use has also been evaluated in specific clinical situations. Consensus recommendations, as well as other considerations, follow.


Intradialytic Parenteral Nutrition Intradialytic PN (IDPN) should not be used as the primary nutrition intervention in patients who are malnourished and have chronic kidney disease (CKD).6


Because IDPN typically only provides 500 to 1,000 kcal


per dialysis treatment and intermittent dialysis treatments are provided 2 to 3 times per week for most patients, IDPN can only play a supplemental role for patients with CKD who are malnourished and unable to tolerate adequate oral or enteral intake. Existing data suggest IDPN is safe for selected patients, but the risks, complications, and financial costs have not been thoroughly studied.6,16


Perioperative Parenteral Nutrition


EN is generally preferred in the preoperative period, but preoperative PN may be considered for patients who are severely malnourished and unable to tolerate adequate oral intake or EN.6


Postoperatively, PN may


be appropriate for patients who are severely malnourished and unable to tolerate EN for more than 7 days.6


9


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