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1148 Parenteral Nutrition

• If performed for more than a few hours, • Animals requiring more than a day or two Pearls
this is an invasive, high maintenance, and of O 2 supplementation usually require Nasal O 2 supplementation is extremely useful
VetBooks.ir • Reserved for severely affected animals and by turning down the flow rate (or FIO 2 for and dogs that consistently breathe through the
but less so for cats, brachiocephalic dog breeds,
gradual weaning off O 2 over 12-72 hours
expensive means of O 2 supplementation.
in facilities that can provide intensive care.
O 2 cages) with repeat assessment of clinical
mouth.
Postprocedure condition. SUGGESTED READING
• Ideally, animals requiring more than short- Alternatives and Their Boyle J: Oxygen therapy. In Creedon JM, et al,
term O 2 supplementation should be managed Relative Merits editors: Advanced monitoring and procedures for
in a 24-hour care facility so that they can • There are no good alternatives to O 2 supple- small animal emergency and critical care, ed 1, West
be closely monitored for improvement or mentation for treatment of hypoxemia. Sussex, UK, 2012, John Wiley & Sons.
deterioration. • Animals with anemia can have tissue hypoxia AUTHOR: Adesola Odunayo, DVM, MS, DACVECC
• Assessment of oxygenation is important, without having hypoxemia and can benefit EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
whether by arterial blood gas analysis (p. from transfusion therapy. Thompson, DVM, DABVP
1058) or pulse oximetry.

Parenteral Nutrition Bonus Material
Online

Difficulty level: ♦♦ septic complications and drug-nutrient ○ Many of the complications of PN
interactions. can be life-threatening, and careful
Synonyms ○ Treat catheter placement as a surgical monitoring of the patient is mandated.
Total parenteral nutrition (TPN), partial par- procedure (p. 1123). This includes frequent checks of serum
enteral nutrition (PPN), peripheral parenteral ○ A central venous catheter is preferred to glucose and electrolyte concentrations;
nutrition (PPN) deliver PN because the nutrient solution is some in-house serum chemistry analyses
hyperosmolar. Dilute solutions can be used necessary.
Overview and Goals for peripheral venous infusion, but the
• Parenteral nutrition (PN) is nutrition resulting large volume can be a limiting Anticipated Time
delivered by the intravenous (IV) route. factor. • Patient assessment and PN prescription for-
• Used when enteral feeding is not possible ○ Catheters made of nonthrombogenic mate- mulation can take 30-60 minutes depending
and the need for nourishment is a critical rials (polyurethane or silicone) are preferred, on the complexity of the case and the PN
factor in clinical outcome. particularly for peripheral infusion. formulation.
○ Multilumen central or peripherally placed • Nutrient admixture compounding can take
Indications central catheters (PICC lines) can be used 30-60 minutes depending on the facilities
Patients need nutritional support when if one of the ports is dedicated for PN. and equipment available.
• Enteral nutrition is contraindicated (e.g., • Nutrient admixture • The overall duration of parenteral nutritional
severe gastrointestinal [GI] dysfunction) ○ Amino acid solutions (3%-10%) are used support will depend on the underlying
• Sufficient nutrition cannot be provided by the for providing protein. These solutions disease and the patient’s response.
enteral route alone (e.g., severe malabsorptive come with and without added electrolytes.
disease). ○ Nonprotein calories can be provided by Preparation: Important
a combination of lipid emulsions (10% Checkpoints
Contraindications or 20%) and dextrose (10%-50%) or Nutrient admixture:
• Patients that can be fed safely and effectively dextrose alone. • Prepare PN solutions under aseptic condi-
by an enteral route, even if feeding tubes are ○ Electrolytes can be added to the nutrient tions. Solutions must be compounded in a
required solution as needed or provided separately specific sequence and carefully mixed.
• Patients that are at risk with catheter in the patient’s crystalloid fluid therapy. • Use the services of a home infusion service
placement The latter allows greater flexibility. Alter- or a human hospital pharmacy to compound
○ Central venous catheters in patients at natively, a combination amino acid and PN solutions when the veterinary practice
high risk for thromboembolic disease (e.g., electrolyte solution can be used. lacks the facilities and expertise.
protein-losing nephropathy or enteropathy ○ Special parenteral vitamin and mineral
[p. 600], hyperadrenocorticism [p. 485], preparations are available. However, Possible Complications and
disseminated intravascular coagulopathy because most companion animals receive Common Errors to Avoid
[p. 269]) PN for relatively short periods (<2 weeks), • Common metabolic complications
○ Jugular catheters in patients with increased only certain vitamins and minerals are ○ When addressing electrolyte abnormalities,
cerebral pressure (e.g., head trauma) commonly added to the nutrient admix- delivering supplements in the IV fluids
• Patients at risk of fluid overload (e.g., ture (B complex ± potassium phosphate rather than in the PN solution allows
patients with heart failure, oliguria, or severe and magnesium sulfate). greater flexibility. Later, when the amount
hypoproteinemia) • Monitoring and nursing care of supplementation for maintenance is
○ PN is best delivered continuously established, it can be included in the PN
Equipment, Anesthesia (although not absolutely necessary), and formulation.
• Venous access 24-hour nursing care is desirable for ○ Hyperglycemia: if present, reduce the
○ A dedicated catheter is required for administration and for catheter vigilance/ percentage of nonprotein calories from
nutrient solution delivery to avoid catheter care. dextrose, or give regular insulin (p. 251).

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