Monitoring Parenteral Nutrition | Clinical Nutrition LAM Initiative

Monitoring Parenteral Nutrition

Guidelines for Monitoring Parenteral Nutrition

Once the need for parenteral nutrition (PN) has been established and nutritional requirements are determined, PN should be introduced progressively and monitored closely. The risk of PN-associated complications such as re-feeding syndrome, hypertriglyceridemia, hyperglycemia, catheter infections, and bone demineralization can be minimized by carefully and systematically monitoring the clinical and laboratory parameters.1,2

The Importance of Biochemical Monitoring

During the early phase of PN, particularly for patients with critical illness, biochemical monitoring (blood glucose, urea, electrolytes, and blood gases) should be performed daily. The full set of laboratory parameters should then be repeated two to three times a week after reaching the estimated or tolerated nutritional requirements (see chart below).3

In patients receiving total PN the possibility of supplemental feeding via enteral/oral means should be considered within regular re-evaluation.1 Regular monitoring of PN can result in reduced complications and lower costs.1

The guidelines for monitoring of PN include:1

  • Always monitor water and electrolyte balance, blood glucose, triglycerides, cardiovascular and renal function
  • Enhanced monitoring in patients with altered organ function, lipid infusions, and in critically ill patients
  • Monitoring in patients receiving long-term PN should be performed under standardized procedures, including determinants of bone metabolism

Nutritional and Clinical Monitoring

The following parameters should be monitored and documented on a regular basis:1,4

  • Nutritional monitoring
    • Products used, infusion rate, total amount of nutrients/ solution provided
    • Achievement of nutritional goals
    • Body weight
    • Clinically manifest signs of malnutrition
  • Clinical monitoring
    • State of consciousness
    • Edema/ hydration status
    • Abdominal status
    • Vital functions
      • Respiratory rate, breathing, gas exchange
      • Heart rate, blood pressure
      • Water and electrolyte balance, acid/base status, pH
      • Hematocrit, osmolality
    • Renal function (urine volume, plasma urea and creatinine)

      The following guidelines are for monitoring of metabolic parameters (exemplary schedule):4

      Exemplary schedule of metabolic monitoring parameters

      • 1. a. b. c. d. e. Hartl W, Jauch KW, Parhofer K et al. Complications and monitoring - Guidelines on parenteral nutrition. Chapter 9. Ger Med Sci 2009;7(17).
      • 2. Allison SP, Cynober L, Stanga Z et al. Monitoring of nutritional support. In: Sobotka L, editor. Basics in Clinical Nutriton. Prague, Galen 2011:419-432.
      • 3. Sobotka L, Wanten G, Camilo ME. Metabolic complications of parenteral nutrition. In: Sobotka L, editor. Basics in Clinical Nutrition. Prague: Galen 2011:411-417.
      • 4. a. b. Austrian Society of Clinical Nutrition (AKE). Recommendations for enteral and parenteral nutrition in adults. Vienna 2008.

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