Parenteral Nutrition

Parenteral nutrition is appropriate when patients are unable to maintain nutrition through oral or enteral means. This occurs when patients do not have enough functioning small intestinal mucosa in continuity to absorb the nutrients they need and/or have limitations to enteral feeding (ie high output proximal fistulas, severe dysmotility, etc). The following provides an overview of parenteral nutrition principles including appropriate patient selection, nutrition delivery routes, and common complications.

It is recommended to first watch the introductory lecture and then review targeted readings. A worksheet with sample clinical scenarios can then be used to practice ordering TPN, which should ideally also be augmented with a rotation with the inpatient nutrition support team (when available).

The readings can be reviewed as following:

1. Characteristics Recommended for the Identification and Documentation of Adult Malnutrition

2. When is Parenteral Nutrition Recommended?

3. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

4. Liver Dysfunction in Patients Receiving PN

5. Trace Element Monitoring & Therapy for Adult Patients Receiving Long-term TPN

6. Management of PN Induced Cholestasis

7. Drug-Nutrient Considerations in Patients Receiving Parenteral Nutrition

8. Home Parenteral Nutrition Support for Intestinal Failure

9. Management of Catheter Related Infections in PN Patients

The American Society for Parenteral and Enteral Nutrition (ASPEN) has additional online resources here:

Parenteral Nutrition: https://www.nutritioncare.org/PNResources/

Targeted Readings

TPN Practice Worksheets