Consultative Total Parenteral Nutrition Teams: The Effect on the Incidence of Total Parenteral Nutrition‐Related Complications

Abstract

A two part, prospective study was undertaken to establish the existing frequency of total parenteral nutrition-(TPN) related mechanical, metabolic, and septic complications in an institution with a consultative TPN team (group A) and to determine if increasing the involvement of the TPN team in patient monitoring and verifying adherence to TPN infection control guidelines would reduce the incidence of these complications (group B). The initial 28 consecutive patients were managed entirely by their primary physicians with the role of the TPN team limited to consultative activities while the next 29 patients receiving TPN were managed jointly by their primary physicians and the TPN team. Analysis of the results show group B to have a significant reduction in metabolic complications, decreased incidence of mechanical abnormalities, and approximately equal incidences of documented sepsis. However, when compared to the results of an institution in which the TPN team has complete control of TPN therapy, even the group B patients had a relatively excessive number of TPN-related complications especially in the categories of mechanical and metabolic abnormalities. Thus, consultative TPN teams do not necessarily ensure optimum TPN therapy and institutions using this approach to provide nutrition parenterally must be prepared to establish the incidence of TPN-related complications and to expand the involvement of the TPN team as required to control the frequency of these anomalies.

Does a multidisciplinary total parenteral nutrition team improve patient outcomes? A systematic review

“…The sample sizes in the trials were generally small and ranged from 28 2 to 285, 17 subjects, with 5 studies having unequal sample sizes between the comparison groups. 3,5,6,15,17 The mean duration for the administration of TPN therapy ranged from 7.1 days 2 to 26 days 16 and was administered using either a central [3][4][5][6][12][13][14][15]17 or peripheral 4,5,12 venous catheter. In 2 studies, 2,4 patients received oral and or enteral nutrition during the transitional phase of TPN therapy.…”

“…[2][3][4][5][6]12,13,15,17 None of the studies demonstrated a statistically significant difference in the incidence of potassium abnormalities in patients who were managed by the TPN team and those not managed by the TPN team.…”

Limited long-term survival after in-hospital intestinal failure requiring total parenteral nutrition

“…Studies that investigated the role of a nutrition support team indicated a reduced inappropriate TPN use, less catheter-related sepsis, and even improved survival (14)(15)(16)(17)(18)(19). These outcomes were already shown in the 1980s (18,19). The improved efficacy of TPN use resulted in reduced costs in most studies (14)(15)(16).…”

Assessing the Nutrition Support Team

“…Numerous papers have associated the establishment of an NST with improved clinical outcome and/or reduction in costS.25, 28,30,34,66,[70][71][72][73][74][75][76][77][78][79][80][81][82][83] The apparent implication of such data is that every hospital should have an NST. A difficulty with interpreting and implementing such a conclusion is the wide variability in already established NSTs, as discussed above.…”

“…Of the 133 medical centers that responded, 45% had already formed an NST, and another 15% were in the process of doing so. A repeat survey24 done in 1983 revealed that, by then, 80.5% (of 149 hospitals that responded) had an NST.…”