Complications associated with parenteral nutrition in hospitalized patients

Malnutrition is common in hospitalized patients. Parenteral nutrition is a therapeutic alternative to meet the nutritional requirements of patients in whom the gastrointestinal tract is unavailable or non-functional. This therapy has been associated with a wide range of infectious, mechanical and metabolic complications. The aim of the study was to assess the incidence of these complications.

A prospective multicenter observational study in hospitalized adult patients receiving parenteral nutrition ≥72 h was conducted. Follow-up was performed until one week after the discontinuation of parenteral nutrition. Data were collected from electronic medical records and parenteral nutrition validation programs (Kabisoft and Clinus). Risk of malnutrition was determined according to MUST or CONUT criteria. The main variables were: incidence of catheter-related bacteriemia, catheter-tip colonization, phlebitis, thrombosis, catheter obstruction, catheter malposition, pneumothorax, hyperglycemia, hypertriglyceridemia, hypercholesterolemia, hepatobiliary disorders and refeeding syndrome. A descriptive analysis was performed using SPSS v23 software.

Sixty patients were included, with a median age of 68 (28-90) years, 48.3% men and a body mass index of 26.2 ± 6.6 kg/m². Of these, 61.7% were surgical patients and 46.7% were at low risk of malnutrition. Parenteral nutrition was administered for a median of 10 (3-40) days, 90.0% through central access. Patients received a mean of 18.4 ± 5.0 kcal/kg/day (74.7% of requirements), 1.1 ± 0.4 g/kg/day of protein, 2.4 ± 0.7 g/kg/day of glucose, and 0.5 ± 0.2 g/kg/day of lipids. Of them, 35% received concomitant enteral nutrition. Overall, 80.0% experienced at least one complication: metabolic (71.7%), mechanical (18.3%), and infectious (10.0%). Incidences were: hepatobiliary alteration (61.7%), hyperglycemia (48.3%), phlebitis (13.3%), catheter occlusion (8.3%), catheter-related bacteriemia (8.3%), hypertriglyceridemia (1.7%), hypercholesterolemia (1.7%), and colonization (1.7%). Gram-positive microorganisms were the most frequently isolated.

Although complications associated with parenteral nutrition occur, the rate of serious complications, such as infections, is low. While most patients experienced at least one complication, metabolic events were the most common, and they are generally ease to detect and manage. The incidence of mechanical complications, mainly phlebitis and catheter occlusions, was moderate.