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Parenteral Nutrition: Principles, Indications and Complications

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Introduction

Parenteral Nutrition is a form of feeding where a person feeds intravenously by passing the normal way of eating and digestion. Persons with gastrointestinal disorders require a full bowel rest, including bowel obstruction, short bowel syndrome and prolonged diarrhea (Hamilton, 1991). Parenteral nutrition prevents malnutrition in patients unable to obtain the sufficient nutrients by oral or enteral routes. There are the two types of parenteral nutrition; partial parenteral nutrition and total parenteral nutrition, with differences in being the makeup of the solutions and the site of administration. Total parenteral nutrition is given when the patient requires an extended period of intensive nutritional support.  Total parenteral nutrition provides the patient with the calories he requires and prevents the body from using protein for energy. It is given using a fusion pump. Partial parenteral nutrition is given to patients who can tolerate some oral feeding, but cannot ingest enough food to their nutrition requirements. The most common combination of solutions used is lipid emulsion and amino acid-dextrose solutions (Howard, 1988). Parenteral nutrition solution nutrients have amino acids, carbohydrates, vitamins, fats and minerals in a mixture intended to meet the needs of the patient. This solution is administered to the blood through the use of intravenous catheter attached to a large vein in the chest or arm.                                                                 

Principles

With parenteral nutrition, there is the possibility of averting malnutrition that will improve the life or the ability to recover from serious illness. This feeding method has proven beneficial to some patients.                                                                 Indications  Pre-existing Nutritional Deprivation  Whenever a patient has a pre-existing problem of scarcity of nutrients; it is always wise that parenteral nutrition be administered. Malnutrition is a common clinical problem. Patients who have a high risk of infections have more impaired psychological functioning and a poorer clinical outcome (Shulman & Philips, 2003).                                                                          

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Inadequate Oral Nutrition Intake  When a patient is not able to eat through the normal process because of either gastrointestinal blockage or infection, parenteral nutrition is always a recommended option. Significant Multi-organ System Disease Renal, Cardiac and gastrointestinal diseases reduce the amount of nutrients uptake and cause the hyper catabolism. Parenteral nutrition is perhaps the only feasible method of feeding to people with nonfunctional gastrointestinal tract due to blockage, or when its absorptive capacity is impaired.    

Intensive Chemotherapy Patients undergoing cancer treatment through chemotherapy have difficulties when it comes to eating. Through parenteral nutrition, they regain the energy before the introduction of oral food.

Complications

 Infections   

Parenteral nutrition may cause infection at the position of central venous catheter. Patients undergoing long-term therapy, the risk of sepsis spreading to the whole body are high, and can cause death as a result of the septic shock.   Heart and Liver Failure  Patients receiving parenteral nutrition may suffer from the fluid imbalances. Increased levels of dextrose and amino acids cause hyperosmolarity: a condition that leads to dehydration and hypovolemic shock (Lohlein, 1986). Re-feeding Syndrome It consists of metabolic disturbances as the result of the reinstitution of the nutrition patients who are severely malnourished or starved. It occurs to those who lose weight quickly during the period of starvation Hyperglycemia. This problem might arise where a patient receives the solution too quickly, lack of enough insulin and infections. Chronic hyperglycemia leads to complications, such as kidney failure, neurological damage and cardiovascular damage.

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