The total parenteral nutrition service: an update.

A total parenteral nutrition (TPN) service was established in Oxford in 1978 and the results of the first 3 years were published in 1983. Since then the service has provided intravenous nutritional support to an increasing number of patients, representing a considerable and increasing financial burden on the constrained hospital budget. To assess whether this expansion is justified, and whether regular review has improved the care given to patients, a further audit has been performed for the period 1983 to 1986. Despite an increase of approximately 60% in the numbers of patients parenterally fed, line associated morbidity was less and there were no serious metabolic problems or deaths. Patient selection has improved, as judged by fewer patients fed for periods less than a week. Regular audit appears to improve the selection and treatment of patients but there remains a need to identify subgroups of patients for whom this costly form of nutrition is essential.