Parenteral food represents a way of nutritive support during which implementation nutrients are entered intravenously through the central or peripheral venous catheter.
As it is celebrated the last decades in medical literature, parenteral food is less preferable way of nutritive support in comparison with an enteroalimentation. It is connected with its not physiology and a possibility of development considerably of bigger number of complications in comparison with enteral nutritive support. Nevertheless, in the conditions of lack of digestion of nutrients through digestive tract, parenteral food remains the unique option of nutritive support for patients.
Can be indications to purpose of parenteral food:
Intestines paresis lasting more than 3 days ̆, intestinal impassability, abdominal ̆ a compartment syndrome;
Extensive resection thin ̆ guts, syndrome short ̆ guts;
Intestinal fistulas of upper parts thin ̆ guts;
Disturbance of mezenterialny blood circulation;
Malabsorption heavy ̆ degrees;
Inflammatory diseases of intestines in an aggravation stage;
Lack of an opportunity to provide nutritive requirements by means of an enteroalimentation within 5–7 days ̆;
The deficiency of food expressed ̆;
High ̆ risk of development of an aspiration syndrome.
It is also necessary to mean that moment that parenteral food can serve as addition to enteral if the last is not enough for one reason or another.
Parenteral food is followed by risk of development of a hyperglycemia, electrolytic rasstroistvo, overloads the volume (overhydratation), an immunodeficiency, an oxidizing stress and increases frequency infectious a complication ̆. Carrying out parenteral food demands control of level of glucose and electrolytes in blood.
Medicines for parenteral food with high ̆ osmolarity (more than 900 mosm/l) demand introduction through central ̆ venous ̆ access. Administration of such vysokoosmolyarny mixes ̆ in a peripheral vein leads to development of phlebitis. 10% and 15% solutions of amino acids and also 20% and 40% glucose solution belong to vysokoosmolyarny mixes.
Drugs for parenteral food with low ̆ osmolarity (less than 900 mosm/l) it is admissible to enter through peripheral ̆ venous ̆ access. Usually such introduction in peripheral ̆ venous ̆ access, as a rule, is used as addition to an enteroalimentation as owing to low ̆ nutritious ̆ values ensuring full volume of nutrients with such access is accompanied by an overload ̆ volume.
Separate administration of medicines for parenteral food (glucose, amino acids, fatty emulsions) demands use of a set infusional lines ̆ that increases the probability of development infectious a complication ̆. This problem partly can be solved by use of medicines for parenteral food in mnogokamerno ̆ to packing. But at patients with obesity and also at patients to whom restriction of volume infusional ̆ is shown to therapy at patients to whom it is shown individual ̆ selection of a dose of protein and energy, use of separate maintaining medicines is desirable.
On the other hand, use of drugs in mnogokamerno ̆ to packing increases risk of occlusion of a catheter and reduces the term of its service. It is not recommended to store mixes of amino acids and glucose more than 24 hours as at the same time chemical stability of solution owing to a vzaimodeistviye between amino acids and glucose ̆ with formation of the oxidized end products is broken.
The drugs for parenteral food should be administered evenly that improves their comprehensibility. Therefore for administration of such drugs it is expedient to use various infusional pumps which allow to expose a certain speed of infusion and to observe it during the entire period of administration of drug.
When carrying out parenteral food it is expedient to appoint various additives which are not in drugs for intravenous food. Treat such additives macro - and microelements and also vitamins.
At improvement of shipping of an enteroalimentation the volume of parenteral food it is necessary to reduce and stop at achievement more than 60% power ̆ requirements at the expense of enteral. Transition to an enteral way of nutritive support is recommended as soon as possible.