Parenteral nutrition

Parenteral nutrition ( PE ) supplies a patient with fluids and individual nutrients via the blood vessel system through infusions. With this form of artificial nutrition , the digestive tract is largely bypassed ( Greek παρά, para = next to; ἔντερον, enteron = inside, intestines); however, food or liquid can still be supplied orally or enterally . In total parenteral nutrition ( TPE ), all nutrients are administered intravenously, whereas supplementary parenteral nutrition ( SPE ) supplements inadequate oral or enteral nutrition.

Indications

Whenever possible, nutrition should preferably take place naturally (orally) or by tube (enterally via a nasogastric tube or percutaneous endoscopic gastro- or jejunostomy ), since these forms of nutrition largely maintain the physiological absorption of fluids and nutrients in the intestine. There are also risks associated with parenteral nutrition. That is why this form of nutrition is used “on the basis of a treatment objective that is realistic according to medical and nursing assessments and that is largely determined by the patient”.

Parenteral nutrition is therefore particularly suitable for patients who cannot orally or enterally take in any or not enough food and fluid over a long period of time (three days or more). It is possible to feed parenterally in addition to oral or enteral nutrition in order to prevent malnutrition . An inadequate supply of fluids and nutrients quickly leads to deficiency symptoms, especially in infants and the elderly, but also patients with tumors in the head and neck area are very troublesome with chewing and swallowing, so that food cannot be adequately absorbed.

It also affects patients who suffer from diseases of the digestive tract, such as acute pancreatitis , intestinal obstruction or esophageal cancer . If new connections have been made in the gastrointestinal tract ( anastomoses ) during an operation , the patient is fed parenterally for the first few days afterwards to relieve the newly created connection. Another reason for parenteral nutrition are absorption or digestive disorders in the small intestine (such as acute inflammatory phases in Crohn's disease or ulcerative colitis ), short bowel syndrome or an ileostomy , passage disorders ( e.g. peritoneal carcinosis or stenosing tumors in the stomach or intestine) or high fluid losses and electrolytes from diarrhea , insatiable vomiting, or severe burns. Pronounced anorexia (loss of appetite) or nausea , for example during chemotherapy, can also be an indication. In the case of eating disorders such as anorexia , parenteral nutrition is only indicated in exceptional cases.

execution

Parenteral nutrition is usually provided via infusion solutions that are administered intravenously. Since some of the nutrient solutions are highly concentrated, they usually have to be infused into one of the body's large veins via a central venous or port catheter . Peripheral parenteral nutrition is possible if the food bags are expressly suitable for it. Peripheral parenteral nutrition should not be given for more than two weeks. Veins that are far peripheral (for example on the back of the hand) are only suitable for a few days for the infusion of low-concentration liquids, such as isotonic saline or Ringer's solution , because of their thinner vessel walls . If highly concentrated solutions are given through peripheral veins, this leads to burning pain; the veins become inflamed after a short time and the solution gets into the surrounding tissue, which can lead to considerable damage.

Total parenteral nutrition (TPE) consists in the supply of

• water
• Electrolytes
• Carbohydrates (usually in the form of glucose )
• amino acids
• Fats
• Vitamins and trace elements

The amount of parenteral nutrition supplied depends on the energy requirement and the clinical picture. In addition to the basal metabolic rate of 4 kJ / h and kg body weight, up to 4 kJ / h and kg body weight of additional energy needs to be covered by diet, for example if there is sepsis or extensive burns .

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

To carry out parenteral nutrition, for example in intensive care units, a step-by-step scheme can be used:

• Stage 1: hydration with low calorie intake (on the day of the illness event)
• Level 2: Peripheral venous basic nutrition or halved, fully balanced nutrition with additional fluid intake (on the second to third day of treatment)
• Stage 3: Balanced complete parenteral nutrition (with the need for a central venous access).

Alternatives

• semi-calorie nutrition via the arm vein
• subcutaneous hydration

Enteral nutrition:

• PEG probe (percutaneous endoscopic gastrostomy)
• Nasogastric tube

Parenteral Nutrition Problems

The main problem is the colonization of germs in the catheter and the risk of bacterial infections , so that parenteral nutrition over several weeks is difficult. In most cases, new punctures must then be made. To circumvent this problem, a permanent central venous access, such as a port catheter , is often implanted in patients who require parenteral nutrition over a long period of time .

literature

• Georg Kreymann (editor), Otto Nehren (illustrations): DGEM guidelines for enteral and parenteral nutrition: 18 tables. Published by the German Society for Nutritional Medicine , Thieme, Stuttgart 2007, ISBN 3-13-148091-2 .
• Michaela Brandstätter: Parenteral nutrition: indications, techniques, organization. Elsevier, Munich 2002, ISBN 3-437-26750-7 .
• Rudolf Mohr: The azotemia as part of parenteral nutrition: a Retrospektivuntersuchung about the behavior of nitrogen metabolites in the serum for total parental nutrition in intensive care , Heidelberg 1976, DNB 780,771,176 (Dissertation, University of Heidelberg, Department of Clinical Medicine, 1976, 80 pages).
• Peter Schmid: Total parenteral nutrition, indication, practical implementation, long-term progression, complications , Huber, Bern / Stuttgart / Toronto 1991, ISBN 3-456-82018-6 (habilitation thesis University of Magdeburg, Medical Academy, 1990, 339 pages).

Web links

• German Society for Nutritional Medicine eV: Guideline for Parenteral Nutrition

Individual evidence

1. ↑ L. Valentini, D. Volkert, T. Schütz, J. Ockenga, M. Pirlich, W. Druml, K. Schindler, PE Ballmer, SC Bischoff, A. Weimann, H. Lochs: Guideline of the German Society for Nutritional Medicine (DGEM) - DGEM terminology in clinical nutrition. 2013; Pp. 105 and 109 ; accessed on January 4, 2019
2. ↑ F. Oehmichen et al .: Guideline of the German Society for Nutritional Medicine (DGEM). Ethical and legal aspects of artificial nutrition. In: Current Nutritional Medicine 2013; 38; P. 113 ; accessed on January 5, 2019
3. ↑ F. Oehmichen et al .: Guideline of the German Society for Nutritional Medicine (DGEM). Ethical and legal aspects of artificial nutrition. In: Current Nutritional Medicine 2013; 38; P. 113 (principles) ; accessed on January 4, 2019
4. ↑ Michaela Brandstätter: Parenteral nutrition: indications, techniques, organization. Elsevier, 1st edition Munich 2002, ISBN 3437267507 .
5. ↑ J. Stein, K.-W. Jauch: Practical Guide to Clinical Nutrition and Infusion Therapy . Springer-Verlag, March 7, 2013, ISBN 978-3-642-55896-2 , p. 404.
6. ↑ Otto Nehren: DGEM guidelines for enteral and parenteral nutrition: short version. Thieme, Stuttgart 2007, ISBN 3131480912 .
7. ↑ Karsten Schwarting: Parenteral and tube feeding. In: Jörg Braun, Roland Preuss (Ed.): Clinic Guide Intensive Care Medicine. 9th edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8 , pp. 131–149, here: pp. 133–137.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !