Placed for patients requiring two to six weeks of therapy (exception HIV patients). Access is done through one of the larger vessels in the antecubital fossa. The veins used in the adults include the basilic, median cubital, cephalic and accessory cephalic veins. Catheter tip placement MUST be in the superior vena cava (SVC) for TPN. If the catheter tip is outside the SVC, the maximum dextrose concentration should be 10% or less. A PICC line may be placed for home use. Contact your team coordinator for further information.

Indications for Peripheral Parenteral Nutrition

1. Enteral nutrition not feasible or not adequate

2. Supplemental support during adaptation to enteral feeding

Note that in most situations, PPN does NOT supply total nutrition due to the osmolality limits.

Studies available indicate that PPN should be limited to approximately 900 mosm/L to prevent thrombosis and inflammation. This can usually be accomplished by limiting the concentration of dextrose to 10% and amino acids to 3.5%. Lipids are highly recommended to be given as 3-in-1 admixture for PPN to continuously buffer the solution.

Refer to the chart below for the MAXIMUM amounts to prescribe to keep the osmolality at approximately 900 mosm/L. The RATIO OF CARBOHYDRATE:FAT calories will be 50%:50%. The calories provided by dextrose and fat in the table are equally divided which will give overall concentrations of approximately 10% dextrose and 3% fat. If the patient cannot tolerate fat, the calories provided by dextrose alone CANNOT BE INCREASED. A 2.5% increase in dextrose will increase the osmolarity by 125 mosm/liter.

FOR EXAMPLE:Patient requires supplemental support of approximately 1600 kcal/day. Order 2000 ml at 83 ml/hr with 70 grams protein, 667 kcal dextrose and 667 kcal of fat.