Category: Intellectual Nourishment
What good are guidelines and recommendations?
Without guidelines and recommendations, we would live in chaos! We would be back in the Wild West making wild guesses and assumptions. So we have guidelines and recommendations. Not hard and fast like laws, guidelines and recommendations do offer some leeway to use one’s clinical judgment. But because guidelines and recommendations are based on the strongest available scientific evidence, they shouldn’t be ignored. But what good are they really? Let’s look at parenteral nutrition guidelines and recommendations for an example. The American Society for Parenteral and Enteral Nutrition (ASPEN) is a great resource for guidelines and recommendations.
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What do the guidelines say about nutrition support therapy in the adult critically ill patient? The ASPEN-SCCM clinical guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient offer basic recommendations that are supported by review and analysis of the current literature, other national and international guidelines, and a blend of expert opinion and clinical practicality.
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When is parenteral nutrition appropriate? Consensus recommendations by Worthington P, et al, aim to delineate appropriate parenteral nutrition use and promote clinical benefits while minimizing the risks associated with the therapy. Read the full document.
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What is appropriate dosing for parenteral nutrition? Persistent shortages of parenteral nutrition components have led to a tendency of practitioners to provide less than adequate dosing, which can lead to nutrient deficiencies that impair growth and healing. This document provides the requirements and recommendations for dosing of nutrients for a complete parenteral nutrition prescription.
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What about alternative lipid injectable emulsions (ILEs)? There are expert recommendations regarding the use of alternative ILEs in surgical and critical care patients. The 2018 Lipids in Parenteral Nutrition summit involved a panel of experts in clinical nutrition, lipid metabolism, and pharmacology to develop consensus statements regarding the use of alternative ILEs.
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How do I achieve photoprotection for parenteral nutrition? A position paper by Robinson DT, et al, reviews the scientific literature on the formation of quantifiable peroxides and other degradation products when parenteral nutrition admixtures and lipid injectable emulsions are exposed to light and reports adverse clinical outcomes in premature infants exposed to parenteral nutrition.
Whether you have a question on dosing or storage or delivery, there’s probably a clinical recommendation for it. The American Society for Parenteral and Enteral Nutrition (ASPEN) has guidelines and consensus recommendations that are based on literature and practices to help guide the use of parenteral nutrition to minimize errors associated with parenteral nutrition therapy. But that’s just one resource. There are also the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), the European Society for Clinical Nutrition and Metabolism (ESPEN), and the Society of Critical Care Medicine (SCCM).
Whether a patient is in the hospital, a long-term care facility, or is being discharged to home, these guidelines and recommendations exist to help guide the safe and effective use of parenteral nutrition. As a pioneer of clinical nutrition, we believe it’s of the utmost importance to stay on top of these guidelines. That’s why we post any updates and links to these professional societies on our Resources page.
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The 411 on parenteral nutrition
Before we dive into our innovations that nourish, let’s start with the basics.
What is parenteral nutrition? Well, it’s nutrition. It’s nourishment…but not as you may know it. To be more technical, it’s the intravenous administration of nutrition, which may include protein, carbohydrates, fat, minerals and electrolytes, vitamins, and other trace elements.1 When patients are unable to maintain good nutritional status by mouth or through tube feeding formula, they may need parenteral nutrition.1 There are a variety of diseases or conditions that prevent patients from being able to eat, digest, or absorb the nutrition they need, including critical illness, bowel obstruction, GI fistulas, and severe acute pancreatitis.1 In 2014, there were about 34,000 U.S. hospitalized patients receiving parenteral nutrition.2
Did you know that parenteral nutrition can be used outside of the hospital? Patients can receive parenteral nutrition in long-term care facilities and at home. In fact, about 25,000 patients receive parenteral nutrition at home.3 And patients can live well on parenteral nutrition, whether they need it for a short time or a long time.1
What should you know about parenteral nutrition?
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Rapid absorption.
Because parenteral nutrition is administered intravenously, it bypasses the gastrointestinal tract, meaning it doesn’t have to be digested before being absorbed by the blood.1 The parenteral nutrition solution is delivered immediately into the bloodstream to exert its therapeutic effects.4
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Nutritional support for all ages.
Patients of all ages, including infants (yes, infants!), may receive parenteral nutrition.1 According to the 2014 National Inpatient Survey data (the latest available statistics), patients received parenteral nutrition in over 290,000 hospital stays.1 You may be surprised to know that children and newborns made up about 43% of those.1
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There are choices!
There are a lot of parenteral nutrition products available on the market today. And as a pioneer in clinical nutrition, we’re always speaking with experts in the field to find new ways to fulfill the nutritional needs of patients who need parenteral nutrition. We specialize in innovations that help nourish critically and chronically ill patients in a variety of clinical settings. From lipid injectable emulsions to three-chamber bags, our products are designed to help your patients flourish from hospital to home.
To explore our comprehensive portfolio of parenteral nutrition products, click here. Remember to keep checking back for more updates!
References: 1. What is Parenteral Nutrition? American Society for Parenteral and Enteral Nutrition. Accessed September 23, 2021. http://www.nutritioncare.org/about_clinical_nutrition/what_is_parenteral_nutrition/. 2. John J, Seifi A. Total parenteral nutrition usage trends in the United States. J Crit Care. 2017;40:312-313. 3. Mundi MS, Pattinson A, McMahon MT, Davidson J, Hurt RT. Prevalence of Home Parenteral and Enteral Nutrition in the United States. Nutr Clin Pract. 2017;32(6):799-805. 4. Le J. Drug Administration. Merck Manual Consumer Version. Revised October 2020. Accessed September 27, 2021. https://www.merckmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug-administration.
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