Parenteral nutrition (PN) is a complex, prescription-only medicine for the administration of macronutrients, (carbohydrates, protein and lipids), micronutrients (vitamins, trace elements and minerals) and fluid directly into a vein. It is a well-established technique to provide nutritional support to an individual whose gastrointestinal tract is not functioning or is inaccessible. The role of PN is to prevent or correct malnutrition when this cannot be achieved by oral or enteral feeding alone.
Whilst PN is a potential lifesaver, it can also be fraught with potentially fatal complications. For PN to be given safely it requires an accurate assessment of the patient’s nutritional requirements, appropriate constitution and compounding of the PN, safe intravenous access and rigorous monitoring of the patient’s electrolytes and anthropometric response.
Close clinical supervision and adequate monitoring are the only way to ensure early detection of problems in order to limit risks. On some occasions, potential risks can prevent administration of PN when otherwise it would be indicated.
National guidelines were published in ‘Nutritional support in adults: oral nutritional support, enteral tube feeding and parenteral nutrition. Clinical Guideline (CG)32. NICE.2006’. These provide details of the good practice standards to be achieved.
A National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report in 2010 –Parenteral Nutrition: A Mixed Bag was the first national observational study on PN in UK hospital patients and looked at the assessment, administration, catheter care and monitoring of patients receiving PN. Good practice was found in only 19% of adult PN cases and over half of the cases lacked an adequate clinical assessment of the patient’s nutritional needs. The report took a critical look at areas where the care of patients might have been improved and identified remediable factors in the clinical and the organisational care of these patients.
|Compiled by:||Anne Chetwood, Senior Pharmacist|
|Ratified by:||Drug and Therapeutics Committee|
|Date Ratified:||March 2021|
|Date Issued:||October 2021|
|Review Date:||March 2024|
|Target Audience:||All staff|
|Contact name:||Anne Chetwood, Senior Pharmacist|
- Central Venous Catheter Care policy
- Peripheral Venous Catheter Care Policy for Adults
- Peripherally Inserted Central Catheter (PICC) Care Policy for Adults
- Tunnelled Central Venous Access Devices (Hickman) Care Policy For Adults
- Administration of Injectable medicines via the intravenous route policy
- Medicines Management Policy
- Escalation plan for supply problems with PN