There are approximately five million patients who receive some type of nutritional support each year while in the hospital. It has been shown that nutritional status declines while a patient is hospitalized, and up to 50% of patients experience moderate malnutrition. A higher risk of medical complications, such as infections, increased length of stay, and increased mortality is associated with malnutrition. It is essential to provide nutritional support to the critically ill patient to promote the best possible outcome. These patients have increased metabolic needs due to the stress of injury and a catabolic state.

The two potential methods of supplementing nutrition are through enteral and parenteral routes. The choice between these routes should be made by a qualified clinician while considering the patient’s medical condition, nutritional status, and available routes for nutritional support. While parenteral nutrition provides ease of administration and the ability to finely adjust nutrient levels, there are complications to parenteral nutrition that must be considered, such as sepsis, volume control, catheter infection, and lack of maintenance of the gastrointestinal tract. Enteral nutrition does not carry many of these complications, but is more difficult to administer in many cases.

Parenteral nutrition was first described in 1968 and has been used ever since to support critically ill patients. Due to the special pharmaceutical considerations involved in the mixing and administration of parenteral nutrition, pharmacist involvement in parenteral nutrition is essential. For example, pharmacists have special knowledge of which medications can be included in a TPN or can be concomitantly administered through the same intravenous line. This is a unique area for pharmacists to get involved in patient care by constructing and monitoring TPN therapy. This tutorial will introduce you to the skills needed to assess a patient’s nutritional status and construct an appropriate order for parenteral nutrition for the patient.