Postoperative catabolism puts patients at need of tailored nutritional support
Like all significant injuries, major surgeries are severe stress situations for the body. Important organ and regulatory systems such as the cardiovascular system, the immune system, and the neuronal hormones switch to survival-mode in order to protect the most critical organs, creating a metabolic state called catabolism. This state is characterized by the breakdown of energy stores including glycogen and fat as well as muscle protein, releasing glucose, free fatty acids and amino acids for healing and immune response. The resulting loss of muscle mass is a significant long-term burden for the recovery of functional status. Therefore, it is of key importance to avoid long periods of perioperative fasting and the associated accumulation of energy and protein deficits.1
Following major surgery, enteral nutrition is the preferred route of providing nutrients if oral feeding is not possible. If enteral nutrition is contraindicated (e.g. in case of intestinal obstruction) or insufficient (e.g. due to gastrointestinal intolerance) the use of parenteral nutrition (PN) is recommended, alone or in addition to enteral feeding, to bridge the nutritional gap.
Peripheral PN should be considered as a straightforward alternative to central venous feeding
Patients who have difficulty with enteral access or a delay in central venous access, and are at risk of developing a nutritional deficit can be considered for peripheral PN. The insertion of a peripheral intravenous catheter does not require a surgeon or an x-ray for control of the correct placement of the catheter tip, and is the quickest and simplest way of establishing intravenous access. It may well bridge the time until central venous access or adequate enteral feeding can be established.
If a central venous catheter is in place after surgery, PN is usually administered via this route. However, the supply is regularly interrupted during therapeutic or diagnostic procedures and whenever medication is administered via the same route. Experts call for a diligent documentation of delivered amounts of nutrition, commonly failing to reach the prescribed supply.
Patients suitable for peripheral PN have peripheral veins available for cannulation and can handle large amounts of fluid. Sterile working procedures and careful surveillance of the insertion side for the development of thrombophlebitis should be monitored.
Formulas for peripheral PN facilitate safe application
The choice of the peripheral PN solution will contribute to the success of the nutrition therapy: