Assessment for Parenteral Nutrition in Adults


Contraindications for Enteral Nutrition: Indications for Parenteral Nutrition?


Some relative or absolute contraindications to feeding tube placement may require initiation of PN.6 patient individually.


The clinician should carefully evaluate each


ƒ Overall contraindications to obtaining EN access that may neces- sitate PN initiation include mechanical obstruction of the GI tract, uncontrolled peritonitis, uncorrected coagulopathy or thrombo- cytopenia, GI bleeding, or bowel ischemia.


ƒ Contraindications for nasal feeding tube placement may include basilar skull fracture; recent transsphenoidal surgery; facial,


sinus, or nasal trauma; or significant esophageal disease (includ- ing recent variceal banding).


ƒ Contraindications for abdominal feeding tube placement may include massive ascites, hemodynamic instability, morbid obe-


sity, or short duration of use (<4 weeks). References


1. Commission on Dietetic Registration. Nutrition Care Process and Terminology. Accessed August 3, 2024. www. cdrnet . org / nutrition - care - process - and - terminology


2. Academy of Nutrition and Dietetics. Electronic Nutrition Care Process Terminology. 2023. Accessed December 9, 2024. www. ncpro . org / pubs / 2023 - encpt - en


3. Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr. 2001;74(4):534-542. doi:10 . 1093 / ajcn / 74 . 4 . 534


4. Corrigan ML, Bobo E, Rollins C, Mogensen KM. Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: revised 2021 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in nutrition support. Nutr Clin Pract. 2021;36(6):1126-1143. doi:10 . 1002 / ncp . 10774


5. National Board of Nutrition Support Certification, Inc. Candidate Handbook. 2025. Accessed March 5, 2025. https:// nutritioncare . org / nbnsc / wp - content / uploads / sites / 9 / 2025 / 02 / NBNSC - Candidate - Handbook - 2025 . pdf


6. Worthington P, Balint J, Bechtold M, et al. When is parenteral nutrition appropriate? JPEN J Parenter Enteral Nutr. 2017;41(3):324-377. doi:10 . 1177 / 0148607117695251


7. Harvey SE, Parrott F, Harrison DA, et al. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014;371(18):1673-1684. doi:10 . 1056 / NEJMoa1409860


8. Reignier J, Boisramé-Helms J, Brisard L, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018;391(10116):133-143. doi:10 . 1016 / S0140 - 6736(17)32146 - 3


9. Talebi S, Zeraattalab-Motlagh S, Vajdi M, et al. Early vs delayed enteral nutrition or parenteral nutrition in hospitalized patients: an umbrella review of systematic reviews and meta-analyses of randomized trials. Nutr Clin Pract. 2023;38(3):564-579. doi:10 . 1002 / ncp . 10976


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