Serious concerns about the provision of parenteral nutrition in UK hospitals were raised by a national enquiry, which found that poor standards of care are leading to avoidable complications. The Clinical Services Journal reports.
The administration of parenteral nutrition (PN) is a well established technique providing nutritional support to patients who have an inaccessible or non-functioning gut (intestinal failure). As such it is widely used by surgeons, intensivists, paediatricians, neonatologists, oncologists and clinical nutrition specialists. However, while PN is undoubtedly a vital piece of the clinician’s armoury, and a potential lifesaver, it can also be fraught with potentially fatal complications.1 This issue has been highlighted by an investigation into parenteral nutrition, by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD),1 which identified major deficiencies in the current standards of care in UK hospitals. The audit found that only one in five adults (19%) given artificial nutrition are treated to a high standard, alongside just 24% of premature babies – prompting Bertie Leigh, chairman of the investigation, to describe the findings as: “deeply depressing”. Lead report author, Dr James Stewart, NCEPOD clinical co-ordinator and a consultant gastroenterologist, said: “We found that adults are often given this treatment when it is not needed. Care must be improved in the provision of artificial nutrition across all patient groups.”
Parenteral nutrition is the method used to feed patients intravenously when they are unable to absorb sufficient nutrition through their gastrointestinal tract. It is also a mainstay of treatment for premature babies. Co-author, Dr David Mason, NCEPOD clinical co-ordinator and consultant anaesthetist, said: “Premature babies may receive insufficient nutrition for their energy requirements” and called for “those responsible for the provision of PN to pre-term babies to develop greater consensus on its use.” The report1 reviewed the hospital care of 877 adult and 264 neonatal patients who were given PN, and found good practice in less than a quarter of all cases. The enquiry also found clear evidence of poor care and documentation when feeding catheters (central venous catheters or “CVCs”) were inserted. Dr Stewart stated that “CVC insertion is an invasive procedure that carries well recognised risks, which means that it must be properly documented.” He called for improvements in education around CVC insertion and care.
Adult parenteral nutrition
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