Parenteral nutrition is an artificial, venous supply of food when the human digestive tract no longer functions normally as a result of an accident or disease. Today, ready-to-use solutions are available for parenteral nutrition therapy by infusion that contain sufficient amounts of all vital ingredients, such as protein, fat, sugar, vitamins, minerals, or trace elements.
What is parenteral nutrition?
Parenteral nutrition is an artificial, venous supply of food when the human digestive tract no longer functions normally as a result of an accident or illness. The term parenteral comes from the Latin language and means bypassing the gastrointestinal tract. Thus, the normal delivery of nutrition through the mouth to the esophagus into the stomach and intestines is bypassed by parenteral nutrition. The patient is no longer able to independently take in food and deliver it to his or her digestive system. There can be many reasons for this in the form of congenital or acquired diseases or accidental events. This form of artificial nutrition can also take place at home for patients who are permanently dependent on it, following instruction by specialist staff. However, the vast majority of patients receiving this type of care are hospitalized. Depending on the findings, parenteral nutrition may only be necessary temporarily, but in quite a few cases it may be necessary permanently to ensure the patient’s survival. Parenteral nutrition is subject to certain quality guidelines in accordance with the relevant medical societies, which are ensured by certificates. The focus is on patient safety in the provision of nutrition that is administered by a third party, usually nursing staff, bypassing the gastrointestinal tract.
Function, effect, and goals
In parenteral nutrition, all necessary nutritional components enter the blood directly as minute building blocks through venous access. The body then converts these building blocks of fats, proteins, and carbohydrates into energy for the body’s cells as quickly and efficiently as it would during normal digestion. Normally, in healthy people, the food building blocks are absorbed into the blood via the digestive tract, starting in the oral cavity, continuing in the stomach and mainly in the intestine. In patients requiring parenteral nutrition, this mechanism is partially or completely disrupted. Main indications requiring parenteral nutrition therapy are extensive end-stage tumor diseases, acute organ failure, severe infectious diseases, congenital malformations of organs, metabolic derangements, polytrauma, burns, sepsis or intestinal obstruction. Patients after chemotherapy are also sometimes temporarily dependent on artificial nutrition directly through a vein due to mucosal damage to the gastrointestinal tract. Parenteral nutrition therapy pursues clearly defined goals that are strictly oriented toward the patient’s well-being. Thus, the restoration or maintenance of health is paramount, but so is ensuring basic needs in the form of nutritional intake. Furthermore, the maintenance of mobility, the possibility of participating in social life, the preservation and build-up of one’s own body substance, the coverage of individual energy needs as well as the therapy of malnutrition or malnutrition, for example in the presence of anorexia or bulimia. In advanced stages, tumor diseases or anorexia often lead to life-threatening situations due to malnutrition. In such cases, parenteral nutrition can be administered by court order even without the patient’s specific consent. Parenteral nutrition is always tailored to the needs of the individual case. First, the patient’s body weight is used to calculate how much external energy intake is actually required. The aim is to ensure a balanced diet in the form of artificial nutrition bypassing the gastrointestinal tract. Many pharmaceutical manufacturers offer infusion solutions for parenteral nutrition with precisely defined compositions of nutrients. These can be used individually or combined or mixed with other solutions.The decisive factor for the best parenteral nutrition is always the general, current condition of the patient, including his age, height and weight. However, it is not only a matter of supplying nutrients, but also of providing sufficient fluids. This is because patients with dysphagia, such as those with dementia or multiple sclerosis, are unable to drink on their own.
Risks, side effects, and hazards
During parenteral nutrition as a continuous therapy, there are a variety of risks, side effects, and also dangers that can have a direct negative impact on the patient’s health status. Most problems associated with parenteral nutrition occur when hygiene guidelines are not properly followed. When placing infusion pumps, germ-free practices should always be followed, and guidelines for disinfection with follow-up care should be observed. In the home setting, pets should be kept out during preparation, work areas should be surface disinfected, jewelry should be removed, and hands should be thoroughly cleaned. Nursing aids required to create aseptic conditions are covered in full by the statutory health insurance funds in the context of parenteral nutrition therapy. Particularly at the beginning of parenteral nutrition, patients may experience side effects due to the venous introduction of minute nutritional components. These can manifest themselves, for example, in skin changes, chills, cramps, headaches, malaise, shortness of breath or increased body temperature. In these cases, the infusion must be interrupted immediately and the physician informed. Infusion solutions for parenteral nutrition must be stored properly at home, i.e. cool and dry and not above 25°. Expired infusion solutions must not be used under any circumstances. Swelling of the neck and arm on the catheter-bearing side of the body often indicates inflammatory processes at the injection site. The venous access must then be professionally cleaned or replaced altogether.
