Evaluation of Over‐ and Underfeeding Following the Introduction of a Protocol for Weaning From Parenteral to Enteral Nutrition in the Intensive Care Unit

Dervan, Nicola; Dowsett, Julie; Gleeson, Eimear M.; Carr, Susan; Corish, Clare

doi:10.1177/0884533612462899

Cited by 15 publications

(15 citation statements)

References 39 publications

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“…Protocols should visibly illustrate feeding adjustments when volume based feeds are utilized. Advancement orders also need to be coordinated with decreases in PN 65 …”

Section: Section 5 Procure Select/prepare Label and Dispense Enmentioning

confidence: 99%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

349

531

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Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

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“…Protocols should visibly illustrate feeding adjustments when volume based feeds are utilized. Advancement orders also need to be coordinated with decreases in PN 65 …”

Section: Section 5 Procure Select/prepare Label and Dispense Enmentioning

confidence: 99%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

349

531

View full text Add to dashboard Cite

show abstract

“…Dervan and colleagues used a PN weaning protocol in which PN was decreased by 30 mL/h once EN achieved the same rate and was discontinued when EN reached goal infusion rate. They demonstrated less overfeeding with the protocol than prior to the protocol 27 . During times of prolonged weaning, the PN prescription may require daily adjustments with dextrose, amino acids, ILE, and even electrolytes and fluid.…”

Section: Question 13: For Patients Receiving Pn Which Parameters Shomentioning

confidence: 96%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

180

202

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Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings. (JPEN J Parenter Enteral Nutr. 2017;41:324-377) The etiology-based nutrition diagnoses in adults in clinical practice settings are as follows: Starvation-related malnutrition: Chronic starvation without inflammation (eg, anorexia nervosa). Chronic disease-related malnutrition: Inflammation is chronicand of mild to moderate degree (eg, organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity). Acute disease or injury-related malnutrition:Inflammation is acute and of severe degree (eg, major infection burns, trauma, closed head injury). 2,3Malnutrition, pediatric: An imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. It is recommended that growth charts based on a standard deviation z score system be used to track and assess nutrition status in children. 4,5Nutritionally-at-risk: Consider the individual nutritionally-atrisk if any of the following is present. Nutritionally-At-Risk Adult Summary of RecommendationsThese consensus recommendations are designed to identify best practices, guide day-to-day clinical decisions, reduce variations in practice, and enhance patient safety. They are not intended to supersede the judgment of the healthcare professional based on the circumstances of the individual patient.

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“…Heidegger et al recently reported a decreased risk of nosocomial infections in patients receiving adequate amounts of nutrition versus those receiving 77% of energy targets 10 . Overfeeding has similarly been linked with negative health outcomes such as azotaemia, 11 increased MV time, 12 and altered hepatic function 13 . Complications have been suggested to develop when patients are provided with more than 110% of energy needs, 13 as a result of the increased metabolic demand associated with excess substrate provision and increased carbon dioxide production 14…”

Section: Introductionmentioning

confidence: 99%