Peripheral Parenteral Nutrition for Surgical Patients

Patient Selection and Screening

The American Society for Parenteral and Enteral Nutrition recommends that all surgical patients be screened preoperatively for malnutrition and metabolic/catabolic risk using validated tools, such as GLIM criteria, which requires ≥1 phenotypic criterion and ≥1 etiologic criterion, or ESPEN criteria, which requires low BMI or unintentional weight loss combined with either reduced BMI or low fat-free mass index 1, 2
Nutritional support should be provided promptly to all at-risk patients, even if this necessitates delaying surgery, with repeat screening postoperatively when prolonged fasting or catabolism is anticipated 1, 2

The American College of Surgeons indicates that PPN is indicated when patients cannot eat for >5 days or cannot maintain >50% of recommended intake for >7 days perioperatively, or when nutritional goals cannot be met by oral/enteral routes alone, or when central venous catheter is not available or not indicated, or when short-term parenteral support (4-7 days) is anticipated 1, 2
If parenteral nutrition is needed for >7-10 days, transition to central venous access is recommended 1, 2

The European Society for Clinical Nutrition and Metabolism recommends energy and protein requirements of 25-30 kcal/kg ideal body weight per day and 1.5 g/kg ideal body weight per day, respectively, with macronutrient distribution of 50-60% carbohydrates and 30-40% lipids 1, 4
Full supplementation of vitamins and trace elements is mandatory when providing total or near-total parenteral nutrition 4

PPN solutions must have osmolarity ≤850 mOsm/L to prevent thrombophlebitis when administered peripherally 1, 5

PPN can be administered for up to 14 days as a bridge to oral/enteral nutrition or while awaiting central access 5, 3

Evidence demonstrates that PPN prevents postoperative weight loss, reduces complications when micronutrients are included, improves quality of life measures, and shortens hospital stay duration 6, 7

Critical errors include delaying nutritional support in patients who cannot meet needs orally, relying solely on parenteral nutrition when partial enteral nutrition is possible, providing excessive lipids, neglecting micronutrient supplementation, and using PPN beyond 7-10 days without transitioning to central access 1, 5