Original Article
European Journal of Clinical Nutrition (2007) 61, 554–560. doi:10.1038/sj.ejcn.1602547; published online 15 November 2006
Current practices in the delivery of parenteral nutrition in Australia
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.
A B Ali1, C Chapman-Kiddell2 and M M Reeves1,3
- 1Nutrition and Dietetic Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- 2Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- 3Cancer Prevention Research Centre, The University of Queensland, Brisbane, Queensland, Australia
Correspondence: A Ali, Nutrition and Dietetic Services, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland 4102, Australia. E-mail: Azmat_Ali@health.qld.gov.au
Received 15 September 2005; Revised 5 July 2006; Accepted 22 August 2006; Published online 15 November 2006.
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.
Keywords:
nutrition support, clinical practice, total parenteral nutrition
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