Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Current practices in the delivery of parenteral nutrition in Australia

European Journal of Clinical Nutrition volume 61, pages 554–560 (2007)Cite this article

Abstract

Objective:

To determine current practice in the delivery of parenteral nutrition (PN) in Australian hospitals.

Design:

A cross-sectional mail survey.

Setting:

Acute-care adult hospitals with greater than 200 beds in Australia.

Subjects:

A total of 67 hospitals (65.7% response rate).

Intervention:

Surveys were posted to hospitals. A reminder letter with a second copy of the survey was posted 3 weeks later to non-respondents.

Results:

Twenty-seven (40.3%) of the hospitals have a PN team and 50 (74.6%) have a hospital protocol for PN delivery. An inaccessible or non-functional gastrointestinal tract is the most common indicator for commencing PN. Fat infusion is calculated by 24 (38.7%) respondents with a mean (s.d.) maximum amount of fat provided of 2.0 (0.7) g/kg/day. Over half (n=35) reported calculating carbohydrate infusion at a maximum amount of 5.4 (1.0) mg/kg/min. Two-thirds (n=41) reported commencing PN at a rate of 50% or less of goal rate. Blood glucose levels (BGL) were monitored at least once per day by the majority of respondents (n=56, 83.6%). Insulin infusion was commenced at varying BGL. Most respondents (n=40, 59.7%) reported ceasing PN when at least half of the patient's requirements are being met either orally or enterally. A number of practice guidelines were identified and the results of the survey were compared with these guidelines.

Conclusions:

Where there are clear practice guidelines, current practice appears to be in line with these recommendations, however, where evidence is lacking, practice is varied.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • ASPEN Board of Directors and The Clinical Guidelines Task Force (2002). Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN 26, 1S–138S.

  • American Gastroenterological Association (2001). American Gastroenterological Association medical position statement: parenteral nutrition. Gastroenterology 121, 966–969.

  • Australasian Society for Parenteral and Enteral Nutrition (1999). AuSPEN Guidelines for Intravenous Trace Elements and Vitamins. AuSPEN: Melbourne.

  • British Association for Parenteral and Enteral Nutrition Working Party (1996). Current Perspectives on Parenteral Nutrition in Adults. BAPEN: Berks.

  • British Society of Gastroenterology (1996). Guidelines for Artificial Nutrition Support. British Society of Gastroenterology: London.

  • Buchman A (2002). Total parenteral nutrition-associated liver disease. JPEN 26, S43–S48.

    Article  CAS  Google Scholar 

  • Cavicchi M, Beau P, Crenn P, Degott C, Messing B (2000). Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med 132, 525–532.

    Article  CAS  Google Scholar 

  • Chan S, McCowen KC, Bistrian BR, Thibault A, Keane-Ellison M, Forse RA et al. (1999). Incidence, prognosis, and etiology of end-stage liver disease in patients receiving home total parenteral nutrition. Surgery 126, 28–34.

    Article  CAS  Google Scholar 

  • Crook MA, Hally V, Panteli JV (2001). The importance of the refeeding syndrome. Nutrition 17, 632–637.

    Article  CAS  Google Scholar 

  • Druml W, Fischer M, Ratheiser K (1998). Use of intravenous lipids in critically ill patients with sepsis without and with hepatic failure. JPEN 22, 217–223.

    Article  CAS  Google Scholar 

  • Dudrick SJ, Macfadyen Jr BV, Van Buren CT, Ruberg RL, Maynard AT (1972). Parenteral hyperalimentation. Metabolic problems and solutions. Ann Surg 176, 259–264.

    Article  CAS  Google Scholar 

  • Duggan C, Rizzo C, Cooper A, Klavon S, Fuchs V, Gura K et al. (2002). Effectiveness of a clinical practice guideline for parenteral nutrition: a 5-year follow-up study in a pediatric teaching hospital. JPEN 26, 377–381.

    Article  Google Scholar 

  • Fischer GW, Hunter KW, Wilson SR, Mease AD (1980). Diminished bacterial defences with intralipid. Lancet 2, 819–820.

    Article  CAS  Google Scholar 

  • Fraser I, Neoptolemos J, Woods P (1983). The effect of intralipid on human lymphocyte and monocyte function. Clin Nutr 2, 37–40.

    Article  CAS  Google Scholar 

  • Garcia de Lorenzo A, Lopez-Martinez J, Planas M, Chacon P, Montejo JC, Bonet A et al. (2003). Safety and metabolic tolerance of a concentrated long-chain triglyceride lipid emulsion in critically ill septic and trauma patients. JPEN 27, 208–215.

    Article  CAS  Google Scholar 

  • Guenst JM, Nelson LD (1994). Predictors of total parenteral nutrition-induced lipogenesis. Chest 105, 553–559.

    Article  CAS  Google Scholar 

  • Ioannides-Demos LL, Liolios L, Topliss DJ, McLean AJ (1995). A prospective audit of total parenteral nutrition at a major teaching hospital. Med J Aust 163, 233–237.

    CAS  PubMed  Google Scholar 

  • Kalfarentzos F, Kokkinis K, Leukaditi K, Maroulis J, Onoufriou A, Alexopoulos K (1998). Comparison between two fat emulsions: intralipid 30% vs intralipid 10% in critically ill patients. Clin Nutr 17, 31–34.

    Article  CAS  Google Scholar 

  • Marhoffer W, Stein M, Maeser E, Federlin K (1992). Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes. Diabetes Care 15, 256–260.

    Article  CAS  Google Scholar 

  • Monson JFT, Ramsden CW, MacFie J, Brennan TG, Guillou PJ (1986). Immunorestorative effect of lipid emulsions during total parenteral nutrition. Br J Surg 73, 843–846.

    Article  CAS  Google Scholar 

  • Palmblad J (1991). Intravenous lipid emulsions and host defense – a critical review. Clin Nutr 10, 303–308.

    Article  CAS  Google Scholar 

  • Reeves MM, Capra S (2003). Variation in the application of methods used for predicting energy requirements in acutely ill adult patients: a survey of practice. Eur J Clin Nutr 57, 1530–1535.

    Article  CAS  Google Scholar 

  • Rosmarin DK, Wardlaw GM, Mirtallo J (1996). Hyperglycemia associated with high, continuous infusion rates of total parenteral nutrition dextrose. Nutr Clin Pract 11, 151–156.

    Article  CAS  Google Scholar 

  • Rossini AA (1976). Why control blood glucose levels? Arch Surg 111, 229–233.

    Article  CAS  Google Scholar 

  • Solomon SM, Kirby DF (1990). The refeeding syndrome: a review. JPEN 14, 90–97.

    Article  CAS  Google Scholar 

  • Tay SM, Ip-Yam PC, Lim BL, Chan YW (2002). Audit of total parenteral nutrition in adult surgical intensive care. Ann Acad Med Singapore 31, 487–492.

    CAS  PubMed  Google Scholar 

  • The Australian Hospitals Directory (2000): ATA Professional Services Pty Ltd: North Sydney.

  • The EAST Practice Management Guidelines Workgroup (2003). Practice Management Guidelines for Nutritional Support of the Trauma Patient. Eastern Association for the Surgery of Trauma (EAST): Winston-Salem.

  • Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M et al. (2001). Intensive insulin therapy in critically ill patients. N Engl J Med 345, 1359–1367.

    Article  CAS  Google Scholar 

  • Wolfe BM, Mathiesen KA (1997). Clinical practice guidelines in nutrition support: can they be based on randomized clinical trials? JPEN 21, 1–6.

    Article  CAS  Google Scholar 

  • Woodcock NP, Zeigler D, Palmer D, Buckley P, Mitchell CJ, MacFie J (2001). Enteral versus parenteral nutrition: a pragmatic study. Nutrition 17, 1–12.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank all the respondents who willingly completed the surveys. We also thank Dr Peter Kruger and Dr Andrew Pascoe for assistance with proof-reading and editing.

Author information

Authors and Affiliations

  1. Nutrition and Dietetic Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia

    A B Ali & M M Reeves

  2. Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

    C Chapman-Kiddell

  3. Cancer Prevention Research Centre, The University of Queensland, Brisbane, Queensland, Australia

    M M Reeves

Authors
  1. A B Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C Chapman-Kiddell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M M Reeves
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A B Ali.

Additional information

Guarantor: A Ali.

Contributors: ABA initiated and designed the study, carried out data collection and assisted with the interpretation and discussion of results, and writing of the manuscript. CCK initiated the study and assisted in the design of the study and interpretation and discussion of results. MMR carried out data analysis and was responsible for the writing of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ali, A., Chapman-Kiddell, C. & Reeves, M. Current practices in the delivery of parenteral nutrition in Australia. Eur J Clin Nutr 61, 554–560 (2007). https://doi.org/10.1038/sj.ejcn.1602547

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602547

Keywords

Search

Advanced search

Quick links