Parenteral Nutrition Management

Device Recommendations for Administration

The use of an electronic infusion pump with compatible administration sets is considered adequate practice for monitoring pressure and flow of parenteral nutrition, as recommended by Clinical Nutrition guidelines 1, 3
Electronic infusion pumps represent a major technological advancement for the safe administration of parenteral nutrition, according to Clinical Nutrition 1
Portable pumps are preferable to stationary pumps as they allow for greater patient independence, improving their quality of life, as stated by Clinical Nutrition 1, 2
In exceptional circumstances, a flow regulator can be used temporarily, but administration sets with only a roller clamp should not be used, as recommended by Clinical Nutrition 1, 3

The pump must have the capacity to monitor and control the administration pressure of parenteral nutrition, as recommended by Clinical Nutrition 2
Due to the large volume of fluid, the hypertonicity of the parenteral nutrition mixture, and the amount of glucose and potassium administered, rapid or "free-flow" administration can cause serious damage, according to Clinical Nutrition 1, 2
Pumps should include alarms to detect occlusions, air in the line, low battery, and end of infusion, as stated by Clinical Nutrition 2

Regular monitoring of valve pressure is essential to prevent catheter-related complications, such as infections and venous thrombosis, as recommended by Clinical Nutrition 4

For long-term parenteral nutrition (>6 months), tunneled catheters are generally chosen, as recommended by Clinical Nutrition 1, 3
Peripherally inserted central catheters (PICC) can be used if the estimated duration of parenteral nutrition is less than six months, according to Clinical Nutrition 1, 3
The location of the catheter tip at the junction of the superior vena cava with the right atrium reduces the risk of venous thrombosis, as stated by Clinical Nutrition 2
The dressing of the catheter exit site should be done with sterile gauze or a semi-permeable, sterile, transparent dressing, as recommended by Clinical Nutrition 1, 5

Biochemical (electrolytes, renal function, liver function, glucose, hemoglobin, iron, albumin, and C-reactive protein) and anthropometric monitoring should be performed at all visits, as recommended by Clinical Nutrition 4
Measurements of trace elements and vitamins are recommended at 6-month intervals, according to Clinical Nutrition 4
Assessment of bone mineral density by densitometry is recommended at annual intervals, as stated by Clinical Nutrition 4
The intervals between monitoring visits vary, but are typically every 3 months for stable patients, as recommended by Clinical Nutrition 4

Parenteral nutrition-associated liver disease is related to the composition of the parenteral nutrition and the underlying disease, as stated by Clinical Nutrition 4
The fat-to-glucose energy ratio should not exceed 40:60, and lipids should not exceed 1 g/kg per day, according to Clinical Nutrition 4
All forms of overfeeding should be avoided, as recommended by Clinical Nutrition 4
Infections, particularly catheter-related sepsis, should be promptly controlled to avoid deterioration of any hepatic abnormalities, as stated by Clinical Nutrition 4