Use of parenteral nutrition in hospitals in the North of England.

BACKGROUND: Parenteral nutrition (PN) is a costly technology used widely to provide nutrition to patients who have an inaccessible or nonfunctioning intestine. A prospective survey was designed to collect data on PN for inpatients to study the current use of PN, its complications and outcomes in the north of England. The study objectives were to use the Northern Nutrition Network to collect data from all acute hospital inpatients prospectively receiving PN, for 3 months and to provide evidence for current PN practice, and to establish whether this is in line with recognized published clinical guidelines.
METHODS: Using a paper-based collection tool information was recorded on aspects of PN including: total inpatient episodes, patient demographics, indications, duration, venous access used, complications, number returning to enteral feeding and mortality. The presence of a nutrition support team was also recorded.
RESULTS: Data on 193 patient PN episodes were recorded totalling 1708 patient days. The median age of the patients was 67 years. Of these, 158 (82%) were deemed to have a clear indication for PN using the indications cited in the NICE guidelines (http://www.nice.org.uk). The median duration of PN was 7 days (range 1-93). Thirty (16%) patients developed complications due to PN, 23 (12%) had catheter infections which were most common on medical wards. Thirty-nine (20%) patients died within 28 days of PN starting; no deaths were attributable to PN. A total of 118 (61%) patients returned to full enteral feeding. Only three hospitals had nutrition support teams, which had no significant effect on outcomes.
CONCLUSIONS: Parenteral nutrition practice in the north of England is generally in line with current guidelines, however, only three of 15 hospitals had nutrition support teams. Eighteen per cent of patients did not have a clearly documented indication for PN and 15% developed a complication, most often a catheter-related infection.