Parenteral nutrition

1. Administration of Parenteral Nutrition
Course Code: HND-502
Course Title: Clinical and Therapeutic Nutrition
BS Human Nutrition and Dietetics
Dept. of Nutritional Sciences, GCUF
By
Dr. Huma Umbreen

2. Insertion Care
• A skilled nurse can place catheters into
peripheral veins
• Placement of catheters directly into central
veins requires insertion by a qualified
physician.
• Patients may be awake for the procedure and
given local anesthesia.

3. Care of catheter
• Catheter-related problems frequently cause complications
• Catheters are sometimes improperly positioned or may
dislodge after placement.
• Air may leak into catheters, obstructing blood flow.
• Catheters inserted into peripheral veins may cause
phlebitis, requiring reinsertion at an alternate site.
• A catheter may become clogged from blood clotting
• Catheters are also a leading cause of infection:
contamination may be introduced during insertion, at the
placement site, or from a contaminated solution.
• Routine inspections of equipment and frequent monitoring
of patients’ symptoms help to minimize the problems
associated with catheter use.

4. Administration of Parenteral Solution
• A common approach is to start solution infusion
at a slow rate and gradually increase the infusion
rate over a two- to three-day period.
– For example, 40 milliliters per hour may be infused
during the first 24 hours of administration (supplying
960 milliliters) and the rate increased by one liter per
day until the goal rate is reached.
• Another approach is to give the full volume of a
nutrient-dilute solution on the first day and
advance nutrient concentrations as tolerated.

5. Cont….
• Blood glucose and electrolyte levels are
checked regularly to determine tolerance to
solutions.
• Frequent reassessment of nutrient intakes
may be necessary until a patient has
stabilized.
• Rapid changes in infusion rate are discouraged
in some patients (especially newborn infants)
due to a risk of developing hyperglycemia or
hypoglycemia

6. Cont….
• Parenteral solutions may be infused
continuously over 24 hours (continuous
parenteral nutrition) or during 10- to 16-hour
periods only (cyclic parenteral nutrition).
• Continuous feedings are often given to critically
ill and malnourished patients who cannot
receive adequate nutrition during shorter time
periods.
• Cyclic feedings are often provided at night so
that patients can participate in routine activities
during the day.

7. Metabolic Complications
• Hyperglycemia,■ a common consequence of
intravenous feedings, most often occurs in patients
who are glucose intolerant or are undergoing severe
metabolic stress.
• It may be prevented
– by providing insulin along with feedings
– Or by restricting the amount of dextrose in a solution.
• Dextrose infusions are often limited to less than 5
milligrams per kilogram of body weight per minute
in critically ill adult patients so that carbohydrate
intakes do not exceed the maximum glucose
oxidation rate.

8. Cont…
• Hypoglycemia Although uncommon, hypoglycemia
may occur when feedings are interrupted or
discontinued.
• In patients at risk, such as young infants, feedings may
be tapered off over several hours before
discontinuation.
• Hypertriglyceridemia may occur in critically ill patients
who are unable to tolerate the amount of lipid
emulsion that is supplied.
• It may also result from excessive carbohydrate feedings
or from severe infection, which impairs lipid clearance.
• These conditions may limit the amount of lipid
emulsion that can be safely infused.

9. Cont…
• Refeeding Syndrome Severely malnourished
patients who are fed aggressively (parenterally or
otherwise) may exhibit refeeding syndrome,
characterized by electrolyte and fluid imbalances
and hyperglycemia.
• To prevent refeeding syndrome, feedings are
started slowly and electrolyte levels monitored
carefully when malnourished patients begin
receiving nutrition support.

10. Cont…
• Abnormalities in Liver Function Fatty liver often
results from parenteral feedings, and therefore
serum levels of liver enzymes are routinely
monitored.
• Usually, liver complications are readily reversed
when parenteral feedings are discontinued.