ABSTRACT
Parenteral nutrition (PN) is a solution of chemically dened elemental nutrients delivered directly into the bloodstream that is customized to meet the unique and individual nutritional needs of each patient. The delivery of this therapy has evolved
14.1 Introduction .................................................................................................. 321 14.2 PN Indications .............................................................................................. 322
14.2.1 Preoperative PN in Surgical Patients ................................................ 323 14.3 PN Vascular Access Devices ........................................................................ 323
14.3.1 Selection of VADs ............................................................................ 323 14.4 Formulations ................................................................................................. 325
14.4.1 Macronutrients and Micronutrients .................................................. 325 14.4.2 Medications and Additives ............................................................... 328 14.4.3 Solution Composition and Compatibility ......................................... 328 14.4.4 Peripheral Parenteral Nutrition versus Central PN ........................... 329 14.4.5 Infusion Schedule ............................................................................. 329 14.4.6 Solution Considerations for Heart/Kidney Failure ........................... 330
14.5 Monitoring PN .............................................................................................. 330 14.6 Complications ............................................................................................... 331
14.6.1 Metabolic Complications .................................................................. 331 14.6.2 Infectious Catheter-Related Complications ...................................... 334 14.6.3 Noninfectious Catheter-Related Complications ............................... 336
14.7 Other Considerations .................................................................................... 336 14.7.1 Reimbursement ................................................................................. 336 14.7.2 Outcomes .......................................................................................... 338
14.8 Conclusion .................................................................................................... 338 14.9 Case Study .................................................................................................... 339 References .............................................................................................................. 342
over the past 5 decades following the successful infusion of PN by Dudrick and colleagues in the 1960s. PN has been a life sustaining therapy for patients with permanent intestinal failure, who would have otherwise died without PN. Use of PN is not without risk and requires appropriate patient selection, and careful monitoring and the expertise of an interdisciplinary team. This chapter on PN has been designed to target practicing clinicians with information on topics applying the use of PN in both the hospital and at home. Topics will include determining appropriate indications for the use of PN, selection of vascular access, basic components of PN formulas, monitoring PN, as well as preventing and treating PN complications.
