What are the alternatives?

Alternatives to parenteral nutrition are, if possible, enteral or oral nutrition. These two forms of nutrition are always preferable to parenteral nutrition. Enteral nutrition is nutrition via a stomach tube.

It has the advantage that it is easier to administer. In addition, it stimulates intestinal activity and prevents a decrease in the gastric mucosa. Electrolyte imbalances (strong changes in blood salts) are also less frequent with enteral nutrition. If enteral nutrition is not possible for any reason, parenteral nutrition is the last option to ensure adequate nutrition.

Are there any contraindications?

A contraindication is the existing possibility of enteral nutrition. This form of nutrition is always preferable to parenteral nutrition. Other contraindications to parenteral nutrition are metabolic disorders. Even if it is ethically unacceptable or if the patient refuses artificial nutrition, these are contraindications to parenteral nutrition.

Can this be done at home?

Home parenteral nutrition is possible. Care should be provided by an outpatient nursing service or a caring relative. Relatives can learn the correct and safe handling of the accesses and important hygiene measures in various training courses.

Risks and complications

Most complications of parenteral nutrition are due to the catheter or port systems. The catheters may be misaligned and the nutritional solution does not reach the vein but the surrounding tissue, where it can cause irritation. Furthermore, inflammation can occur due to germs in the area of the access routes. A catheter occlusion due to thrombosis (blood clot) is also a possible complication.Incorrectly composed nutritional solutions bear the risk of serious shifts in blood salts (electrolyte derailment) or hyperglycemia.

Composition of the nutritional solution

The nutritional solutions for total parenteral nutrition consist of the following ingredients: Water Electrolytes Carbohydrates (mostly glucose) Amino acids Fats Vitamins and trace elements The individual amount of each substance depends on various factors such as the patient’s energy requirements and whether oral or enteral nutrition is also used. On the one hand, ready-made solutions with fixed proportions of the individual ingredients can be used. Alternatively, the nutritional solutions can also be individually composed and adapted to the patient’s needs. The aim of parenteral nutrition should be to maintain body weight, to maintain all bodily functions and to prevent malnutrition.

Water
Electrolytes
Carbohydrates (mostly glucose)
Amino acids
Greases
Vitamins and trace elements