Is there still a role for peripheral parenteral nutrition?

Peripheral parenteral nutrition (PPN) is often viewed as the stepchild of parenteral nutrition (PN) infused via a central venous catheter. Anecdotal reports suggest that there has been increased interest in PPN in the United States and even more so in Europe because of improvements in catheter design and infusion technology, both of which have the potential to decrease complications such as infusion phlebitis. PPN, like PN via a central venous catheter, contains dextrose, amino acids, electrolytes, vitamins, and minerals, but in more limited capacity. One of the perceived benefits of PPN is the relative ease in establishing peripheral access, which may prevent delays in establishing nutrition support. PPN is intended for short-term use or supplementation. In most instances, it is used to maintain a previously well-nourished, nonhypermetabolic patient or to serve as a bridge to centrally administered infusions or enteral feedings until more suitable nutrition can be provided. In some cases, inappropriate use may result in infusion phlebitis or inadequate nutrient intake. Conflicting recommendations from various organizations further complicate and confuse prescribers. The intent of this review is to discuss PPN and the challenges its use presents to the practitioner.