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Nutrition in ICU

Risks of Parenteral Nutrition

Risks of Parenteral Nutrition

PN received a bad name in studies in the 1980s which showed higher infection rates when PN was compared with enteral nutrition. This is likely to have been the result of practices which led overfeeding and hyperglycaemia, and more recent work suggests that complication rates with both methods of feeding are similar when energy and nitrogen supply is equal. In patients whose gut is working, enteral nutrition is preferred, but in patients who cannot receive adequate enteral nutrition it is now established that PN can be delivered safely with appropriate attention to glycaemic control, prevention of overfeeding and prevention of line sepsis.

Risks of central venous access:

Immediate - haemorrhage, haematoma, arterial puncture, pneumothorax, vessel damage.

Delayed – stenosis, thrombosis, infection.

Infection Risk

Both the line used for PN and the bag of prepared PN are ideal media for infection. Manage the line aseptically; preparation of the feed should be done in a pharmacy dedicated to preparing sterile products.

Gut atrophy

The use of PN in isolation means that the gut has no protection and will atrophy. A very small dose of enteral feed e.g. 10 mls/hour if it can be given may prevent this.

Overfeeding or Refeeding Syndrome

These are a definite risk but should be avoided by careful daily assessment of the patient’s needs.

Hepatic abnormalities

Cholestasis and deranged LFTs are common in patients on PN, but other causes for derangement should be also be sought.

Fluid and Electrolyte Balance

Care should be taken with the amounts of fluid and electrolytes the patient requires and this should be factored into the prescription for the PN; daily monitoring of LFTs, urea and electrolytes, magnesium, calcium and phosphate is essential.

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