Current practices in the delivery of parenteral nutrition in Australia

Objective: To determine current practice in the delivery of parenteral nutrition (PN) in Australian hospitals. Design: A cross-sectional mail survey. Setting: Acute-care adult hospitals with greater than 200 beds in Australia. Subjects: A total of 67 hospitals (65.7% response rate). Intervention: Surveys were posted to hospitals. A reminder letter with a second copy of the survey was posted 3 weeks later to non-respondents. Results: Twenty-seven (40.3%) of the hospitals have a PN team and 50 (74.6%) have a hospital protocol for PN delivery. An inaccessible or non-functional gastrointestinal tract is the most common indicator for commencing PN. Fat infusion is calculated by 24 (38.7%) respondents with a mean (s.d.) maximum amount of fat provided of 2.0 (0.7) g/kg/day. Over half (n=35) reported calculating carbohydrate infusion at a maximum amount of 5.4 (1.0) mg/kg/min. Two-thirds (n = 41) reported commencing PN at a rate of 50% or less of goal rate. Blood glucose levels (BGL) were monitored at least once per day by the majority of respondents (n = 56, 83.6%). Insulin infusion was commenced at varying BGL. Most respondents (n = 40, 59.7%) reported ceasing PN when at least half of the patient's requirements are being met either orally or enterally. A number of practice guidelines were identified and the results of the survey were compared with these guidelines. Conclusions: Where there are clear practice guidelines, current practice appears to be in line with these recommendations, however, where evidence is lacking, practice is varied.