When to Use Parenteral Nutrition

Summary

This video explains the basics of parenteral nutrition, an intravenous method of delivering essential nutrients when the gastrointestinal tract is non-functional. It covers the components of parenteral nutrition, the risks and benefits, and criteria for when to consider it for patients. While life-saving, parenteral nutrition is more expensive and riskier than eating or tube feeding, leading to complications like infections and liver dysfunction. The video also highlights guidelines for patient selection based on their nutritional status and duration without adequate intake, along with the process for weaning off parenteral nutrition.

Takeaways

• 💉 Parenteral nutrition is intravenous nutrition administered through a vein, bypassing the gastrointestinal tract.
• 🍽️ It provides essential nutrients like carbohydrates, proteins, fats, electrolytes, vitamins, trace elements, and water.
• ⚠️ Parenteral nutrition is a life-saving therapy but carries higher risks, including hyperglycemia, gut atrophy, liver dysfunction, infection, and electrolyte imbalances.
• 💸 It is significantly more expensive than alternatives like eating or tube feeding due to the resources required for monitoring and managing complications.
• ⏳ Parenteral nutrition is only recommended when a patient cannot meet their nutritional needs through eating or tube feeding, especially in cases like small intestine obstruction, severe malabsorption, or gastrointestinal bleeding.
• 📊 The nutritional status and the projected duration of inability to eat or use tube feeding are key factors in deciding to start parenteral nutrition.
• 🧑‍⚕️ Patients with at least two criteria for malnutrition, such as unintentional weight loss or muscle depletion, should be started on parenteral nutrition immediately if the gastrointestinal tract is non-functional.
• ⌛ For well-nourished patients, parenteral nutrition can be delayed up to 7 days, but no longer than 14 days, depending on their ability to eat or use tube feeding.
• 📉 Supplemental parenteral nutrition is considered for patients unable to meet over 60% of their energy needs after 7-10 days of tube feeding.
• 📈 Parenteral nutrition should be maintained until the patient can tolerate and meet over 60% of their energy needs through food or tube feeding.

Q & A

What is parenteral nutrition?

Parenteral nutrition is intravenous nutrition, where nutrients are delivered directly into the bloodstream through a vascular access device, bypassing the gastrointestinal tract.

What essential nutrients are provided in a parenteral nutrition solution?

A parenteral nutrition solution can include carbohydrates (dextrose), protein (amino acids), lipids, electrolytes, vitamins, trace elements (such as chromium, copper, selenium, manganese, zinc), and water.

Why is parenteral nutrition considered a last resort for feeding a patient?

Parenteral nutrition carries a higher risk for complications, such as infection, liver dysfunction, gut atrophy, hyperglycemia, and electrolyte imbalances, and is significantly more expensive than alternatives like eating or tube feeding.

In which cases should a patient be considered for parenteral nutrition?

Parenteral nutrition should be considered for patients who cannot meet their nutritional needs through eating or tube feeding, especially if they have gastrointestinal tract dysfunctions, like small intestine obstruction, severe malabsorption, or persistent gastrointestinal bleeding.

What are the risks associated with parenteral nutrition?

The risks include hyperglycemia, gut atrophy, liver dysfunction, infection, electrolyte abnormalities, and overall impaired immune function.

How long can a patient survive on parenteral nutrition?

Patients can survive for days, weeks, or even years on parenteral nutrition, depending on their medical condition and the duration required.

What are the criteria for determining malnutrition in a patient?

Criteria for malnutrition include moderate to severe loss of body fat or muscle mass, unintentional weight loss of more than 5% over one month, more than 7.5% over three months, or more than 10% over six months, and inadequate energy intake.

When should a well-nourished patient start parenteral nutrition?

A well-nourished patient should be monitored for up to 7 days without food or tube feeding before starting parenteral nutrition. The maximum waiting period is 14 days.

How is the decision made to wean a patient off parenteral nutrition?

A patient can be weaned off parenteral nutrition when they are able to meet greater than 60% of their estimated energy needs from food or tube feeding. This is usually determined through close monitoring over 3-5 days.

Can parenteral nutrition be used in combination with enteral nutrition?

Yes, supplemental parenteral nutrition can be used if a patient is unable to meet more than 60% of their energy needs through enteral nutrition after 7-10 days.