Indications for PN

PN should be considered for patients when oral intake or enteral feedings are not possible or are contraindicated for a prolonged period of time. Enteral feedings are the preferred route of administration for specialized nutrition support for many reasons. Enteral feedings are more physiologic and facilitate maintenance of gastrointestinal integrity and function. In comparison with PN, enteral feedings are considerably less expensive and are associated with fewer serious adverse effects. Enterohepatic circulation and barrier function of the gastrointestinal mucosa can be preserved with even small quantities of enteral stimulation. Enteral feedings are associated with a decreased incidence of bacterial translocation and associated sepsis in animal models. PN is indicated when the gastrointestinal tract is not functional, when the safe placement of an enteral feeding access device is not possible, or when the enteral route cannot adequately meet the nutritional needs of a patient. Table 1 lists common indications for PN. When enteral feedings cannot be established within 7-10 days, PN should be considered. Table 2 lists contraindications to the use of enteral feedings.

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