Monitoring and Management

Appropriate monitoring of PN therapy is critical to ensure optimal nutrition therapy is achieved and to prevent complications of PN. Evolution of clinical course and patient condition may warrant changes in the frequency of tests and reevaluation of therapy. Additionally, as PN is transitioned to enteral feedings, tolerance should be monitored and PN should be weaned and discontinued.

PN tolerance should be carefully evaluated upon initiation of therapy. The managing practitioner should consider the patient's clinical condition and concurrent organ function, laboratory measurements, nutrition, and fluid status parameters. Laboratory measurements should include a complete metabolic profile and liver function tests at baseline and subsequent measurements after initiation of PN (Table 7). Electrolytes should be monitored daily until the patient is stable. Monitoring for acute care patients usually requires more frequent laboratory evaluations and more frequent changes to the PN formula than in long-term patients.

Evaluation of visceral proteins, such as albumin or prealbumin, has historically been an important part of nutrition assessment. These markers, however, may not adequately reflect an accurate picture of nutritional status or response to therapy because of other conditions, such as nephropathy, enteropathy, liver disease, or volume overload. Additionally, these visceral protein levels are often

Table 7 Suggested laboratory monitoring

Parameter

Baseline

Initiation

Critically ill patients

Stable patients

CBC with differential

Yes

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