PARENTERAL-NUTRITION

Parenteral nutrition is well established as a lifeline for patients in multiple situations, including the acute care setting and as a permanent requirement. This spectrum challenges the clinician and dietician to design hyperalimentation appropriate to various needs and disease states. Advances in the past year show a growing experience in the routine use of total parenteral nutrition, with a better understanding of complications in long-term administration. Additionally, specific tailoring of treatment for illnesses such as hepatic insufficiency has been critically analyzed. Several new nitrogen moieties are being tested with regard to bioavailability and side effects. The appropriateness of hyperalimentation in the cancer patient continues to challenge use with evidence of both patient benefit and enhanced tumor growth. Finally, the technical aspects of catheter placement, infection, and venous thrombosis remain a subject of interest, particularly in patients sustained with lifelong therapy.