Department of Dietetics and Nutrition, Royal Perth Hospital, Perth, WA, Australia.
Department of Pharmacy, Royal Perth Hospital, Perth, WA, Australia.
Clin Nutr ESPEN. 2023 Aug;56:215-221. doi: 10.1016/j.clnesp.2023.05.020. Epub 2023 Jun 5.
Malnutrition is a common challenge among hospitalised patients and its associatiation with poor patient health-related outcomes places a significant financial burden on the healthcare system. Total parenteral nutrition (TPN) is the primary means for providing nutrition to individuals in whom enteral feeding is not possible but is costly and requires invasive central venous access. Peripheral parenteral nutrition (PPN) provides a suitable option for early nutrition provision in select patients; however, its routine use has been limited by safety and tolerability concerns, with high rates of phlebitis reported in previous studies. The objectives of this study were to review the use, safety, and costs of PPN in an Australian tertiary hospital.
A single-site, prospective observational study was conducted over 15 months in a tertiary hospital. 139 participants (87 male and 52 female) were enrolled in the study. Data collected assessed the indication for PPN initiation, compliance with the hospital's protocols for PPN, total fasting days, the proportion of the patient's total energy and protein requirements provided by PPN, the incidence of phlebitis and potential cost implications associated with the use of PPN.
139 patients (62.6% male), median age 62 years (IQR (interquartile range) 48-74) were enrolled. Most patients had an emergency admission (80.6%) under a general surgical team (84.2%). Forty-eight patients (34.5%) were malnourished, as assessed by the Subjective Global Assessment tool (SGA). Patients fasted for a median of 3 days (IQR 2-5) before PPN commencement, with a median duration of PPN use of 3 days (IQR 2-4). PPN provided an average of 61.6% of the patients' required caloric intake and 46.4% of protein requirements. Progression to TPN was observed in 34.5% of patients. There were low rates of complications with phlebitis observed in 3.7%, extravasation in 1.1%, and no patients developed septicaemia, despite suboptimal compliance with the recommended cannula management guidelines for PPN (66.4% compliant). The cost of PPN was estimated to be AUD$187 per patient day.
PPN is an effective short-term nutrient delivery solution to facilitate early feeding with small numbers of patients requiring transition to TPN. PPN was safe with low rates of cannula complications. Costs were favourable, with potentially significant cost savings as compared with TPN.
营养不良是住院患者常见的问题，其与患者健康相关结局较差有关，这给医疗系统带来了巨大的经济负担。全肠外营养（TPN）是为不能进行肠内喂养的个体提供营养的主要手段，但它成本高昂且需要侵入性中心静脉通路。外周肠外营养（PPN）为某些患者的早期营养提供了一种合适的选择；然而，由于安全性和耐受性问题，其常规使用受到限制，既往研究报告的静脉炎发生率较高。本研究的目的是在澳大利亚的一家三级医院审查 PPN 的使用、安全性和成本。
在一家三级医院进行了为期 15 个月的单站点前瞻性观察性研究。共纳入 139 名参与者（87 名男性和 52 名女性）。收集的数据评估了 PPN 起始的指征、医院 PPN 方案的依从性、禁食天数、PPN 提供的患者总能量和蛋白质需求的比例、静脉炎的发生率以及与 PPN 使用相关的潜在成本影响。
共纳入 139 名患者（62.6%为男性），中位年龄 62 岁（IQR（四分位间距）48-74）。大多数患者为急症入院（80.6%），主要由普通外科团队收治（84.2%）。48 名患者（34.5%）根据主观全面评估工具（SGA）评估存在营养不良。患者在开始 PPN 前平均禁食 3 天（IQR 2-5），PPN 使用时间中位数为 3 天（IQR 2-4）。PPN 平均提供了患者所需热量摄入的 61.6%和蛋白质需求的 46.4%。34.5%的患者进展为 TPN。静脉炎发生率低（3.7%），外渗发生率为 1.1%，尽管对 PPN 推荐的置管管理指南的依从性不理想（66.4%的患者依从），但没有患者发生败血症。PPN 的估计每位患者每天的费用为 187 澳元。
PPN 是一种有效的短期营养输送解决方案，可促进早期喂养，少数患者需要过渡到 TPN。PPN 安全，置管并发症发生率低。成本有利，与 TPN 相比可能有显著的成本节约。
