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Optimal practice review: recommendation reminders detail

Recommendation reminder 3: Peri-operative supplementary parenteral nutrition should not be given to surgical patients unless they are malnourished or at risk of malnutrition (as defined above) and have either: inadequate or unsafe oral and/or enteral nutritional intake; or a non-functional, inaccessible or perforated (leaking) gastrointestinal tract.

Guidance:Nutrition support in adults
Date issued:February 2006

The term nutrition support refers to any method of feeding that aims to improve or maintain the level of nutrients in the body. Nutrition support includes the use of special nutrient-rich foods, nutritional supplements and fortified foods, as well as liquid feed given by a tube into the gut or blood

Malnutrition can occur when a person’s diet does not provide enough nutrients, such as calories, protein and vitamins, to keep them healthy. A person is defined as malnourished if they have any of the following:

     a body mass index (BMI) of less than 18.5 kg/m2

     unintentional weight loss greater than 10% within the last 3–6 months

     a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3–6 months.

A person is defined as at risk of malnutrition if they:

     have eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for the next 5 days or longer or

     have a poor absorptive capacity, and/or have high nutrient losses and/or have increased nutritional needs.

Currently, knowledge of the causes, effects and treatment of malnutrition among healthcare professionals in the UK is poor.

Parenteral nutrition (PN) is the provision of nutrition support through intravenous administration of nutrients such as amino acids, glucose, fat, electrolytes, vitamins and trace elements.  The peri-operative period refers to the time period from admission through surgery until discharge, encompassing pre-operative and post-operative periods.

Some of the common reasons why patients receive PN include the stomach may be slow to recover after an operation, and there may be a delay before the patient can eat and drink; intestine blockage; and weight gain required before an operation.  PN does have associated risks, including infection and blood clots, and should only be used when there is no alternative method of feeding available. 

Based on its review of the evidence, the NICE Guideline Development Group recommended that surgical patients should not be given peri-operative supplementary parenteral nutrition unless they meet the criteria specified in the recommendation.

This page was last updated: 10 March 2009

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.