(414) Evaluation of Peripheral Parenteral Nutrition Practices at a Community Teaching Hospital

Introduction: The American Society for Parenteral and Enteral Nutrition (ASPEN) clearly outlines when parenteral nutrition (PN) is indicated. Additionally, ASPEN and SCCM produced a consensus statement to outline dosing goals for PN. It was observed at the study site that Peripheral Parenteral Nutrition (PPN) is overused and inadequately providing appropriate nutrition for patients. The objective of the study was to assess utilization of PPN at the study site. It was hypothesized that PPNs are inappropriately initiated and frequently do not meet adequate nutritional goals.

Methods: This was a retrospective, observational study in a community teaching hospital. Patient data was collected via a report from the eMR that identified all patients receiving PN from 4/5/2022 through 4/4/2023. Exclusion criteria were then applied to include only adult patients receiving 1 or more days of PPN. The data points collected included: age, gender, PN indication, appropriateness of PN, total days of PPN if applicable, total days of PN, percentage of caloric goals met, infiltration/extravasation occurrences, and ordering service line/physician. An individual charts were reviewed for each patient to help identify appropriate need for PN based on the ASPEN criteria as well as all other data points.

Results: There were 58 PPN orders evaluated for the 21 different patients identified over the study year. Fourteen (67%) of the patients met criteria to receive PN. Of these PPN orders, zero met nutritional goals. The percentage of nutritional goal met ranged from 25-68%. The mean was 53% while the median similarly was 55%. Eight of the 21 PPN patients (38%) were administered for a total of only 3 days or less (3 x 1 day, 3 x 2 day, and 3x 3 day) and never escalated to TPN before resuming enteral nutrition. Only 5 of the 21 patients who received PPN ever reached nutritional goal parenterally. From a safety standpoint, 2 patients (9.5%) experienced line infiltration leading to reversal with hyaluronidase.

Conclusions: In conclusion, PPN is not used appropriately at the study site. Given that 33% of PPN patients did not qualify for PN per ASPEN guidance and zero of the PPN orders met patient nutritional goals while still posing a safety risk accounting for 2 infiltrations, the study site plans to no longer allow PPN administration.