Safety and impact of peripheral parenteral nutrition on nutrient delivery in patients with nutrition risk: A prospective observational study

Abstract

Background Malnutrition is common in hospitalized patients and strategies to improve energy and protein intake have a positive impact on outcome. Despite early evidence suggesting the usefulness of peripheral parenteral nutrition (PPN), its adoption has been hampered by concerns regarding safety and efficacy. This study addresses this issue. Methods This prospective observational study was performed in medical and surgical inpatients in who were screened for nutrition risk and assessed using Subjective Global Assessment (SGA). Data captured included nutrition status, energy and protein requirements, intravenous access, indications for PPN, use of supplemental micronutrients, and disposition of patients on PPN. Results Ninety‐eight patients were recruited from two centers over 8 months. The average age was 61.5 years, the mean Charlson Comorbidity Index was 4.21 (±3.09), 52% were male, and 48% were admitted to medicine, whereas 52% were admitted to surgery. Thirty‐three percent of patients were SGA C, 44% were SGA B, and 19% were SGA A. Twenty‐seven percent of patients had cancer. The average length of hospital stay was 22 days. The main indications for PPN were gastrointestinal tract dysfunction (72%) and postsurgical status (16%). PPN provided an average of 1296 kcal (±191) and 46 g of protein (±7). Intravenous access complications in patients receiving PPN did not occur in excess of expected. Almost 40% of patients required transition to central PN. Conclusions PPN is a safe, effective way to deliver supplemental protein, energy, and micronutrients to malnourished patients and supports transition to other modes of nutrition care.

Risk Factors for Bloodstream Infection in Patients Receiving Peripheral Parenteral Nutrition

“…Most patients require 25 kcal/kg/day, with 0-1 g/kg/ day of nitrogen (1). However, intravenous fluids other than PPNs typically provide only 170 kcal/L without proteins (23). Dextrose content is insufficient for complete nutritional support.…”

Parenteral Nutrition Overview

“…However, midline VADs are still prone to phlebitis, and their deeper location may mask relevant signs and symptoms of phlebitis [ 3 , 20 ]. Age may also play a role in the development of phlebitis, and adults, especially elderly patients, are more likely to develop phlebitis compared to pediatric patients [ 21 , 22 ]. Thus, it is reasonable to limit peripheral PN < 900 mOsm/L for pediatric patients and <800–850 mOsm/L for adults [ 3 , 6 , 22 , 23 ].…”

“…As midline catheters are becoming an increasingly popular way to administer PN in the hospital setting, the use of PPN is also growing, particularly in acute pancreatitis (AP), inflammatory bowel disease (IBD) and surgical patients [ 21 , 46 , 47 , 48 ]. In fact, PPN is largely used in the perioperative period for selected patients, as it has been included in some perioperative procedures [ 47 , 49 ].…”

“…In fact, PPN is largely used in the perioperative period for selected patients, as it has been included in some perioperative procedures [ 47 , 49 ]. In fact, PPN is currently used for a wide variety of clinical and logistical reasons [ 21 , 46 ]. However, the disadvantages of PPN, such as low concentrations of macronutrients, large fluid volumes, and the risk of phlebitis, may limit the provision of adequate nutrition.…”