Improving Access to Parenteral Nutrition (PN) in the Hospital: What the Hospitalist Needs to Know about Supplemental PN, Lipids and Safe Use-Improving Access to Parenteral Nutrition (PN) in the Hospital PDF

Improving Access to Parenteral Nutrition (PN) in the Hospital PDF

Pdf Summary

This symposium, held with SHM Converge 2026 and supported by an educational grant from Fresenius Kabi, focuses on improving hospital access to parenteral nutrition (PN) and safe use of supplemental PN (SPN), lipid emulsions, and multi-chamber bag PN. It is jointly provided by Partners for Advancing Clinical Education and ISMP, with 1.0 AMA PRA Category 1 Credit available.<br /><br />The program emphasizes that PN is a life-sustaining, high-alert therapy used when oral or enteral nutrition is not feasible or adequate. Presenters review when to start PN based on individual clinical factors, including nutritional status, metabolic stability, and goals of care. Evidence suggests that in the first week of critical illness, PN and enteral nutrition often have similar outcomes, while SPN should generally not be started before day 7 in ICU patients, though malnourished or high-risk patients may warrant individualized consideration.<br /><br />The session also covers alternative injectable lipid emulsions: soybean oil, olive/soy blends, four-oil mixtures, and fish-oil products. It explains their benefits, dosing, essential fatty acid deficiency prevention, triglyceride and liver monitoring, and how lipid choice may affect risks such as intestinal failure-associated liver disease. Guidance is included for lipid shortages, such as conserving product, prioritizing high-need populations, and resuming full dosing when shortages resolve.<br /><br />A major theme is medication safety. PN contains many components and errors can occur at ordering, verification, compounding, and transitions of care. The symposium highlights standardized formulations, especially multi-chamber bag PN, as a way to reduce compounding steps and errors. Hospitalists are encouraged to confirm indications, choose the safest formulation, avoid unnecessary customization, and reassess daily in collaboration with pharmacy and nutrition support teams.

Keywords

parenteral nutrition

supplemental PN

lipid emulsions

multi-chamber bag PN

hospital access

medication safety

critical illness nutrition

ICU patients

lipid shortages

essential fatty acid deficiency