29-32: Complications of Parenteral Nutritional Support

Parenteral nutrition is considered a high-risk nutrition therapy, which can result in mechanical, infectious, and metabolic complications, for which patients require close monitoring for prevention, detection, and treatment.

Catheter-related complications can occur during insertion or while the catheter is in place. Pneumothorax, arterial laceration, air emboli, and brachial plexus injury can occur during catheter placement. Radiographic imaging must be performed to confirm proper placement of central venous access prior to initiating parenteral nutrition. Additional catheter-related complications include thrombotic occlusions and non-thrombotic occlusions caused by drug-nutrient interactions, precipitates, and residue.

Catheter-related bloodstream infections are the most serious of all complications. Patients with indwelling central vein catheters in whom fever develops without an apparent source should have their lines removed or changed immediately, at which time the catheter tip should be cultured, and empiric antibiotics initiated. Quantitative tip cultures and blood cultures narrow antibiotic therapy. Catheter-related sepsis occurs in 2–3% of patients even if optimal efforts are made to prevent infection. “Central line bundles” are evidence-based practices designed to reduce the incidence of central line–associated infections.

Metabolic complications of central vein nutritional support include hyperglycemia, hypoglycemia, EFAD, hypertriglyceridemia, fluid and electrolyte abnormalities, hepatobiliary disorders, and metabolic bone disease. A skilled nutritional support clinician is needed to safely prescribe, monitor, and address potential parenteral nutrition–associated complications. Examples of metabolic complications and suggested solutions are outlined in Table 29–4.