Parenteral Nutrition Guidelines

Indications for Parenteral Nutrition

The American Society for Parenteral and Enteral Nutrition recommends parenteral nutrition for patients with intestinal failure requiring parenteral nutrition when enteral absorption is inadequate to sustain life 1
The American Society for Parenteral and Enteral Nutrition recommends parenteral nutrition for critically ill patients who cannot be adequately nourished enterally within 5-7 days 2
The American Society for Parenteral and Enteral Nutrition recommends parenteral nutrition for patients with acute liver failure or decompensated cirrhosis when oral/enteral nutrition is ineffective or not feasible 3, 4
The American Society for Parenteral and Enteral Nutrition recommends parenteral nutrition for patients with acute renal failure, particularly those on continuous renal replacement therapy 5, 6
The American Society for Parenteral and Enteral Nutrition recommends parenteral nutrition for patients with malnutrition who cannot achieve adequate oral intake despite counseling and oral nutritional supplements 1

The American Society for Parenteral and Enteral Nutrition recommends 0.8-1.0 g amino acids/kg/day for metabolically stable adults on home parenteral nutrition 1
The American Society for Parenteral and Enteral Nutrition recommends 0.8-1.5 g/kg/day for critically ill ICU patients, with optimal protein-sparing effects achieved at 1.3-1.5 g/kg/day in trauma and sepsis 2, 5
The American Society for Parenteral and Enteral Nutrition recommends total energy provision of 20-35 kcal/kg/day, with non-protein energy at 100-150 kcal per gram of nitrogen 1

The American Society for Parenteral and Enteral Nutrition recommends standard amino acid solutions at 0.8-1.0 g/kg/day for patients with compensated cirrhosis 3, 4
The American Society for Parenteral and Enteral Nutrition recommends BCAA-enriched solutions (35-45% BCAA content) with reduced aromatic and sulfur-containing amino acids for patients with hepatic encephalopathy 3, 4
The American Society for Parenteral and Enteral Nutrition recommends 0.4 g nitrogen/kg/day (approximately 2.5 g amino acids/kg/day) to achieve positive nitrogen balance for patients with acute renal failure on continuous renal replacement therapy 2, 5
The American Society for Parenteral and Enteral Nutrition recommends 0.55-0.60 g/kg/day of high biological value protein for patients with chronic renal failure (conservatively treated) 7, 6

The American Society for Parenteral and Enteral Nutrition recommends glutamine supplementation at 0.2-0.4 g/kg/day (equivalent to 0.3-0.6 g/kg/day alanyl-glutamine dipeptide) for patients receiving parenteral nutrition in the ICU 2, 5
The American Society for Parenteral and Enteral Nutrition recommends thiamine administration at 100-300 mg IV daily, with 300 mg given before starting nutrition therapy in refeeding syndrome patients 8

The American Society for Parenteral and Enteral Nutrition recommends central venous access (tunneled catheters or implanted ports) for long-term parenteral nutrition; PICC lines are not recommended for home parenteral nutrition 1
The American Society for Parenteral and Enteral Nutrition recommends cyclic administration over continuous infusion 1
The American Society for Parenteral and Enteral Nutrition recommends infusion pumps for controlled delivery 1

The American Society for Parenteral and Enteral Nutrition recommends biochemistry and anthropometry at all visits for home parenteral nutrition patients 1
The American Society for Parenteral and Enteral Nutrition recommends trace elements and vitamins every 6 months 1
The American Society for Parenteral and Enteral Nutrition recommends plasma electrolytes to avoid hypokalaemia/hypophosphataemia after initiating nutrition (refeeding syndrome) 6
The American Society for Parenteral and Enteral Nutrition recommends liver function tests regularly, as parenteral nutrition-associated liver disease relates to composition and underlying disease 1