Indications and Contraindications of Parenteral Feeding

Indications and Contraindications of Parenteral FeedingThe primary indication for the use of parenteral feeding is that sufficient calories cannot be ingested or absorbed enterally.

Common Indications for PNInability to absorb adequate nutrients via the GI tract :Massive small-bowel resection / short bowel syndromeSevere, untreatable steatorrhea / diarrhea / malabsorptionComplete bowel obstruction, or intestinal pseudo-obstructionProlonged acute abdomen or ileus

Severe catabolism & GI tract unusable within 57 daysEnteral access not feasible, not adequate or not toleratedPancreatitis with intolerance (eg pain) of jejunal nutritionHigh output EC fistula (>500 mL) & no distal enteral access

Potential Indications for PNEnterocutaneous fistulaIBD unresponsive to medical therapyHyperemesis gravidarum persistent for > 57 days and enteral nutrition not possiblePartial small bowel obstructionIntensive chemotherapy / severe mucositisMajor surgery if enteral nutrition unlikely for >710 daysIntractable vomiting if jejunal feeding not possibleChylous ascites or chylothorax when low2 Major ContraindicatonPresence of a functioning gastrointestinal tractExistence of a terminal condition for which aggressive therapy is not provided

Contra-indications to PNFunctioning gastrointestinal tractTreatment anticipated for < 5 days in patients without severe malnutritionInability to obtain venous accessPoor prognosis that does not warrant aggressive nutrition supportWhen the risks of PN are judged to exceed the potential benefits

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