Parenterale Ernährung - Grundlagen und Durchführung (Parenteral nutrition - basics and good practice)

The physiological nutrition goes by the oral route. If an adequate and sufficient nutrition enterally is not more possible, a parenteral nutrition allows a partial or total feeding. Fluids and nutrients are usually administered as all-in-one admixtures using a central venous access. A parenteral nutrition (PN) is contraindicated when enteral nutrition is possible. Compared to enteral, PN is more complex, more demanding and potentially accompanied by serious or even fatal complications. PN requires a strict aseptic working, a pharma- ceutical correct admixture of suited macro- and micronutrients to ensure the necessary stability and compatibility. The dosing and ad- ministration of the (reactive) components have to respect the me- tabolic needs and the metabolic capacity (tolerance) of the patient and need appropriate monitoring. Medical, pharmaceutical, nutri- tional advice and nursing support is required. In addition, the nec- essary administrative and cost-related tasks and the periodically re- view of the indication, of the composition of the nutrition regimen including the administration details have to be regularly checked. An efficacious PN requires experience, an adequate monitoring and quality assurance and regular, documented training of the nutrition support team, the patient and the family member involved. Since the PN is a complex, a therapeutically demanding treatment with involvement of different partners in and outside of the hospital (in- terfaces), the incidence of “medication errors” can be prevented or reduced.