Synopsis
Use parenteral nutrition only for a defined gastrointestinal failure, prescribe a complete individual admixture safely, and prevent catheter, metabolic, hepatic and refeeding complications through specialist monitoring.
- Parenteral nutrition is indicated when oral and enteral routes are unsafe, inadequate or impossible because the gastrointestinal tract cannot absorb or be accessed sufficiently; it is not a shortcut around feeding difficulties.
- Define the intestinal problem, expected duration, treatment goal and exit strategy before insertion of vascular access, involving the nutrition-support team early.
- A complete prescription accounts for energy, amino acids, glucose, lipid, electrolytes, vitamins, trace elements and fluid, with daily individualisation during unstable illness.
Key red flags
Rigors with hypotension, confusion, mottling or lactate elevation in a patient with central access requires immediate sepsis treatment after cultures when safe and must not await proof of line infection.
Investigation priorities
Confirm indication, estimate requirements and identify a feasible route transition.
Management branches
Nutrition goals cannot be met safely through oral or enteral routes because gut function or access is inadequate.
- Define the gastrointestinal mechanism, predicted duration, prior route optimisation, refeeding category and patient-centred objective.
- Refer to the multidisciplinary nutrition-support team to estimate requirements and choose peripheral or central access with a documented rationale.
Key medicines
Individualised parenteral nutrition admixtureInfuse the pharmacy-approved daily formulation through the designated access at the prescribed rate and duration, using a pump and aseptic connection.
Thiamine and multivitamin preparationProvide before and during initial nutritional escalation according to refeeding risk, route reliability and the local nutrition protocol.