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Debunking the Myths Against Parenteral Nutrition: What the Evidence Says?

Marianne Aloupis, MS, RD, CNSC, LDN; Practice Specialist and Clinical Educator, Clinical Nutrition Support
Service at the Hospital of the University of Pennsylvania
Philadelphia, PA

Disclosures
I have no commercial relationships to disclose

Presentation Overview/Summary
Parenteral nutrition (PN) has been an available nutrition therapy for several decades. Early research
demonstrated that there may be high risk of infectious complications, metabolic disturbances and hepatic
dysfunction associated with PN use. Recent practice standards have improved outcomes associated with PN.
Care bundles for placement and maintenance of central venous access devices have resulted in lower rates of
central line associated bloodstream infections. Newer data related to PN in hospitalized patients has
demonstrated that outcomes related to infectious risk and mortality are similar when comparing early initiation of
PN to early initiation of enteral nutrition. The use of soybean oil intravenous lipid emulsions (ILE) has been
considered a potential risk factor for development of complications associated with PN, including infections and
liver dysfunction. New generation ILE options are reviewed as well as the evidence to support their indications for
use in clinical practice.

Learning Objectives
At the conclusion of the presentation, the learner will be able to:

1. Understand the value of optimal management of central venous access devices to reduce PN risk.
2. Recognize the impact of recent evidence related to risks and benefits of parenteral nutrition (PN).
3. Leverage new evidence to enhance nutritional support practices, including potential indications for new

intravenous lipid emulsions.

Key Takeaways
1. Recent evidence supports the use of parenteral nutrition to provide nutrition support in patients unable to
tolerate adequate enteral or oral intake.
2. Standardized management of central venous access device placement and maintenance, along with
optimal macronutrient dosing and close monitoring will reduce risks associated with PN use.
3. New generation ILE’s may provide some benefit in patients requiring PN. More research is needed to
clearly define the clinical indications and outcomes of different types of ILE’s.

Learning Assessment Questions
1. Based on clinical guidelines related to CVAD selection in the setting of PN, clinicians should choose the
smallest device with as few lumens as required to meet the needs of the patient.
A. True
B. False

2. Recent evidence has shown that there is no significant difference in which of the following outcomes
when comparing PN to EN or standard care:
A. Infectious risk and mortality.
B. Weight gain and muscle loss.
C. Metabolic clearance.
D. Liver dysfunction.

3. Withholding soybean-based ILE from PN for 7-10 days has been shown to significantly reduce infectious
complications in all ICU patients on PN.
A. True
B. False

4. Due to different lipid sources in alternative ILE’s, there may be a higher risk for development of:
A. Hypertriglyceridemia
B. Carnitine deficiency
C. Essential fatty acid deficiency
D. Cholestasis

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