CPD practice profile

Parenteral nutrition Parenteral nutrition is an intravenous method of providing nutrition to patients by delivering nutrients directly into the bloodstream via a venous access device. It is prescribed by a specialist nutrition support team, which may include a pharmacist, specialist nutrition nurse, dietician and doctor, to ensure that it is given appropriately and safely. The nutrition support team will make decisions about the length of treatment, usually in conjunction with the patient’s primary medical or surgical team, the prescription and the mode of administration. A bag of parenteral nutrition comprises water, glucose, fatty acids, amino acids, electrolytes, vitamins and minerals, and it is formulated according to the patient’s requirements. To provide the patient with a balanced nutrient intake, the nutrition support team assesses the patient in relation to the indication for parenteral nutrition, and the patient’s medical history, weight and recent weight loss, wounds, fluid balance, blood test results and clinical condition. In addition, the nutrition support team should assess the patient for risk of refeeding syndrome. If this is likely, the patient’s prescription should be low in calories. The calorie content should be increased slowly over several days in conjunction with close monitoring.

Venous access

Parenteral nutrition can be administered via a peripheral venous access device if the formulation has an osmolarity


Reading a CPD article improved Kirsten Devaney’s monitoring of patients receiving parenteral nutrition

of 850mOsm/L or lower. However, this administration route carries a high risk of thrombophlebitis. It is suitable for most patients for a short period of time, because such a low osmolarity solution would also be low in calories. When administered peripherally, the cannula should be changed every 24-48 hours.

This practice profile is based on NS702 Fletcher J (2013) Parenteral nutrition: indications, risks and nursing care. Nursing Standard. 27, 46, 50-57.

Parenteral nutrition solutions of higher osmolarity (total nutrient requirements) are administered via a central venous access device (CVAD), which is the preferred device for most types of parenteral nutrition. There are risks associated with the use of parenteral nutrition, primarily catheter-related bloodstream infection. Because of the increased risk of such infections, it is recommended that only single-lumen CVADs are used. If signs of infection are present, the device should be removed at the earliest opportunity. Other risks include haemothorax, air embolism, haemorrhage and nerve injury. Formulation-related risks include hyperglycaemia because of the high glucose content, fluid imbalance, electrolyte imbalance and liver dysfunction. To ensure safe care, the nurse should monitor the patient’s blood glucose levels and observe for signs of oedema, decline in liver function and fluid or electrolyte imbalance. Patients receiving parenteral nutrition should be monitored closely by nursing staff and the nutrition support team. It is essential to ensure that a holistic approach is taken and the patient receives adequate nutrition with minimal complications NS Kirsten Devaney is a staff nurse on the gastroenterology ward at the Royal Liverpool University Hospital

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Parenteral nutrition.

Parenteral nutrition is an intravenous method of providing nutrition to patients by delivering nutrients directly into the bloodstream via a venous ac...
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