Parenteral nutrition

Parenteral nutrition (PN ) is a form of the artificial diet in the digestive tract to be bypassed.

Indications

Parenteral nutrition is used in all patients in question, over a longer period of time (3 days or more ) can not be adequately nourished enterally, so orally or via a nasogastric tube. This applies to patients suffering from acute diseases of the digestive tract, such as pancreatitis, ileus or an esophageal carcinoma; but also patients who have been created in the course of an operation new compounds in the gastrointestinal tract ( anastomoses ), are nourished in the first few days after surgery to relieve the newly created connection in this way. Another reason for a pE are resorption or digestive disorders of the small intestine ( such as in acute inflammation phase of Crohn's disease or ulcerative colitis), the short- bowel syndrome, Passage disorders ( eg peritoneal or stenosing tumors of the stomach or intestine) or critical underweight, for example, caused by high losses (diarrhea, ileostomy, frequent vomiting ), but also by massive loss of appetite or nausea eg during chemotherapy. In eating disorders such as anorexia is only exceptionally the indication for parenteral nutrition. It is possible to additionally or exclusively parenteral feeding, to prevent malnutrition. It is important to be individual metabolism and in particular amino acids needs to improve the general condition of the patient.

Implementation

The diet takes place usually on special solutions that are administered intravenously. Since the solutions are highly concentrated, they must be infused via a central venous catheter permanently in one of the large veins of the body. The usually thinner arm veins are unsuitable; Infusions also cause burning pain and the veins become inflamed after a short time.

The total parenteral nutrition consists in the supply of:

• Water
• Electrolytes
• Carbohydrates ( mostly in the form of glucose)
• Amino acids
• Fats
• Vitamins and trace elements

The amount of the fed parenteral nutrition depends on the energy demand and the clinical picture. In addition to the basal metabolic rate of 4 kJ / h and kg body weight, depending on whether, for example, sepsis, or a large-scale combustion exists to cover up to 4 kJ / h and kg body weight of additional energy needs through diet.

The nutritional needs of the body should be covered (usually by glucose solutions ) to 20 to 35 percent from fats, and 10 to 15 percent of amino acids 50 to 60 percent by carbohydrates.

Alternatives

• Halbkalorische Feed on the arm vein
• Subcutaneous hydration

Enteral Nutrition:

• PEG tube (percutaneous endoscopic gastrostomy )
• Gavage

Problems of parenteral nutrition

Main problem is the bacterial colonization of the catheter and the risk of bacterial infections, so parenteral nutrition for several weeks is difficult. It must then usually take place again punctures. To work around this problem, in patients requiring parenteral nutrition over a longer period, often a permanent central venous access, such as a port catheter implanted.