PURPOSE: Traditionally physicians as well as patients have tried to fed the patients with higher calories to improve immunity and healing. It has been demonstrated that most patients can be fed 100% to 120% of estimated BEE. At our institution we undertook the initiative to assess the use of Peripheral parentral nutrition therapy at our institution.
METHODS: Prospective randomized chart review of 21 patients on peripheral parenteral nutrition (PPN) used at our institution in July 2010 was conducted. Energy requirement were calculated by clinical dieticians, by using the Harris-Benedict Equation. Activity factor as well as injury factors were assessed. On the basis of nutritional assessment patients were classified into high risk group [cancer or surgery patients -(N=8)], medium risk group [sepsis, dysphagia, chemotherapy associated gastroenteritis, & pancreatitis), length of PPN use (3+ days), enteral nutrition use or other diet type, (N=10)] and low risk [diagnosis (poor oral intake, malnutrition, dysphagia, diverticulitis), length of PPN use (2+ days), enteral nutrition use or other diet type, (N=3)].
RESULTS: 10/21 patients (47.6%) were placed on nothing per oral (N.P.O) status prior to PPN, N.P.O. duration prior to PPN ranged from 0 to 72 hours, 5/21 (23.8%) were N.P.O. for 24 hours prior to PPN. The results are shown in Table 1. The mean total PPN (Kcal) received by our patients was 2623.1+ 808.3. Mean additional calories (Kcal) of 1052.4 + 613.3, received by our patients came from other sources, such as diprivan, IV dextrose, tube feedings and oral diet while patients were being managed on PPN therapy. It showed as in Table 1 that 80% of our patients on PPN therapy at our institution were being overfed. Mean length of stay on PPN therapy was 8.8 + 8.8 days.
CONCLUSIONS: Contrary to normal belief by physicians, nursing staff, patients and families, over 80% of patients at our institution has been overfed during the study period.
CLINICAL IMPLICATIONS: Protocol and procedures have been designed along with education to prevent overfed and underfed situations at our institution
DISCLOSURE: The following authors have nothing to disclose: George Udeani, Salim Surani
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