Parenteral Nutrition (PN) is the feeding of an individual intravenously through bypassing the normal process or procedure of eating and digestion. As a result, the individual receives nutritional formulas which contain glucose, salts, added vitamins, lipids, and amino acids. Parenteral nutrition is, thus, a form of nutrition which is delivered through the vein and does not use the digestive system. This form of nutrition can therefore be given to individuals who are not capable of absorbing nutrients via the intestinal tract due to either vomiting that can’t be stopped, intestinal diseases or severe diarrhea. The advent of parenteral nutrition processes or techniques has led to the long-time survival of individuals who could otherwise be unable to meet the nutritional requirements which are necessary to sustain their lives (Dudrick et al., 1968). Some of the basic principles that have been used in parenteral nutrition include the maintenance of the central catheter, solution formulas, psychological implications and potential complications (Skipper, 2011).
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The complications that are associated with PN can be divided into those which occur as a result of either short-term or long-term administration of PN. Parenteral nutrition is known to be both a complex and life saving process for certain patients. While one group of sufferers can derive a lot of benefit from parenteral nutrition administration, another one can respond negatively towards the process. Diseased people who are known to benefit from the administration of PN comprise those that have the inability to tolerate the adequate oral nutrition for body weight maintenance. The administration of PN is considered to be a realistic option for such people. Patients with inadequate bowel motility or bowel length also benefit from the therapy. Many sufferers of the short bowel syndrome (SBS) and motility disorders are most likely to need the administration of Home Parenteral Nutrition (HPN) for a prolonged period of time due to some clinical conditions which do not allow to use oral nutrition. Short-term Parenteral Nutrition course is prescribed to pancreatitis patients who cannot tolerate the use of nasojejunal feeding, and patients having enterocutaneous fistulae, and other conditions in which feeding through gastrointestinal or GI tract is a contraindication.
Standards of practice to be used in specialized nutrition support for patient care were published by the “American Society for Parenteral and Enteral Nutrition (A.S.P.E.N)” which stresses the multidisciplinary nature of PN patients management. The standards require that sufferers receiving PN should be educated to perform all the necessary tasks during the process in an appropriate way and also partner in the assessment of efficacy and complications. Joly and Messing summarized the medical literature regarding the incidence of complications associated with Parenteral Nutrition. The authors ascertained that complications resulting from Parenteral Nutrition occurred in 2% of cases per annum. They further suggested that specific nutrition goals and outcomes should be created before starting Parenteral Nutrition and regularly monitored during the application of the therapy.
Complications associated with Parenteral Nutrition can be categorized into two types, that is, short-term and long-term. Short-term complications are those which are known to occur in a patient within thirty (30) days of initiating the Parenteral Nutrition. Other complications occurring in the patient after 30 days are known to be long-term. Parameters should therefore be established to monitor both types of complications. Estimation of primary data obtained from hospitalized patients indicated an overall complication rate of between 13% and 20%. Economic costs resulting from complications of Parenteral Nutrition was ascertained to be over $ 100,000 per patient annually.
Dehydration is known to be a major short-term complication in patients receiving Parenteral Nutrition. Many sufferers who are in need of PN normally have SBS characterized by surface area and bowel length which are inadequate for the sufficient absorption of the necessary nutrients. In addition, the output of stool is high and frequent thus complicating the maintenance of hydration in adequacy. This may result in intravascular hydration and thus further cause complications in patients who are in need of Parenteral Nutrition. Many of these patients may thus experience difficulty in maintaining adequate hydration. The situation can further be complicated due to insensible fluid losses during summer and warm weather. With free water depletion, an increase of Chloride and Serum sodium will be observed in such patients. (Weinstein & Plumer, 2007).
There are various long-term complications associated with the administration of Parenteral Nutrition. These long-term complications are divided into two main categories, namely those that affect the systems’ organs and those that do not affect them. Some of the systems’ organs that can be affected as a result of PN complications include bones, kidney and liver. Concerning the other organs, some of the long-term complications are associated with excess or deficiency of nutrients, such as fat, vitamins and trace metals. Other complications that are long-term by nature involve issues which are difficult to measure like, for instance, the quality of life (QOL) (Wilson, 2009).
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In conclusion, patients receiving Parenteral Nutrition are usually complex patients who have many medical complications or problems. Besides being unable to tolerate oral nutrition in adequacy, PN management of such patients is very challenging. The input obtained from clinicians and other health care providers is known to affect the well-being of the patient directly.