Peripheral parenteral nutrition use outside of a dedicated nutrition support service: A descriptive cohort study

Hospitalized patients may require nutrition support because of inadequate intake or impaired gut function. Enteral nutrition is preferred over parenteral nutrition because of fewer complications and earlier return of gut function. This study describes peripheral parenteral nutrition (PPN) use in an Australian tertiary center, evaluating its indications, incidence of adverse effects, and outcomes without the support of a nutrition support service.

All PPN prescriptions from May 2019 to December 2023 were retrospectively identified from pharmacy dispensing records. Demographic, admission, and clinical outcome data were collected from electronic medical records.

During the study period, 761 patients were identified to have received an initial course of PPN. Of these, 335 (44.0%) patients were women, with a median age of 66 (interquartile range [IQR], 54-77). The median duration of PPN was 3 days (IQR, 1.5-4), with a maximum of 20 days. The most frequent contraindication to enteral nutrition was bowel obstruction or ileus (n = 273). For 334 (43.9%) patients who received PPN, there was no documented contraindication to enteral nutrition. After cessation of PPN, most patients transitioned to oral intake alone after a median of 3 days. Thrombophlebitis and venous thrombosis were reported in 2.0% and 0.8% of cases, respectively.

When unrestricted, a high proportion of individuals were inappropriately prescribed PPN. The unnecessary use of PPN exposed patients to potential complications and risks. As a result, PPN prescription should be managed by a dedicated nutrition support service.