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June 26, 1972, Vol 220, No. 13 >
ARTICLE | June 26, 1972

Guidelines for Total Parenteral Nutrition FREE

Maurice E. Shils, MD, ScD
[+] Author Affiliations

Authorized for publication by the Council on Foods and Nutrition. Philip L. White, ScD, Secretary.

Reprint requests to AMA Department of Foods and Nutrition, 535 N Dearborn St, Chicago 60610.


JAMA. 1972;220(13):1721-1729. doi:10.1001/jama.1972.03200130051010
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References

Total parenteral nutrition is a procedure capable of maintaining patients in good condition for prolonged periods while underlying disease is being treated. Achievement of this goal presents problems in formulation, in sterile preparation, and in safe administration of the nutrient solution. A practical program is outlined for simple, inexpensive, and sterile preparation of standard solutions in closed systems. Indications and precautions for this potentially life-saving treatment are discussed together with consideration of routes of administration, ancillary equipment, and nutrient requirements for total parenteral nutrition.

REFERENCES

1 +
Shils ME:  Intravenous feeding—nutritional aspects . Postgrad Med 36:A99-A107, 1964;.
2 +
Dudrick SJ, Wilmore DW, Vars HM, et al:  Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss in an adult? An affirmative answer . Ann Surg 169:974-985, 1969;.
3 +
Filler RM, Eraklis AJ, Rubin VG, et al:  Long-term total parenteral nutrition in infants . New Eng J Med 281:589-594, 1969;.
4 +
Shils ME, Wright WL, Turnbull A, et al:  Long-term parenteral nutrition through an external arteriovenous shunt. Report of a case . New Eng J Med 283:341-344, 1970;.
5 +
Elman R: Parenteral Nutrition in Surgery . New York, Paul B. Hoeber, 1947;, pp 1-13.
6 +
Geyer RP:  Parenteral nutrition . Physiol Rev 40:150-186, 1960;.
7 +
Ellison EH, McCleery RS, Zollinger RM, et al:  The influence of caloric intake upon the fate of parenteral nitrogen . Surgery 26:374-383, 1949;.
8 +
Rice CO, Orr B, Treloar AE, et al:  Parenteral nutrition in surgery . Arch Surg 61:977-991, 1950;.
9 +
Merrill JP: The Treatment of Renal Failure , New York, Grune & Stratton Inc, 1955;, pp 88-89.
10 +
Watkin DM, Steinfeld JL:  Nutrient and energy metabolism in patients with and without cancer during hyperalimentation with fat administered intravenously . Am J Clin Nutr 16:182-212, 1965;.
11 +
Dudrick SJ, Wilmore DW, Vars HM, et al:  Long-term total parenteral nutrition with growth, development and positive nitrogen balance . Surgery 64:134-142, 1968;.
12 +
Wilmore DW, Dudrick SJ:  Safe long-term venous catheterization . Arch Surg 98:256-258, 1969;.
13 +
Atkins RC, Vizzo JE, Cole JJ, et al:  The artificial gut in hospital and home. Technical improvements . Trans Am Soc Artif Int Organs 16:260-266, 1970;.
14 +
Corso JA, Agostinelli R, Brandriss MW:  Maintenance of venous polyethylene catheters to reduce risk of infection . JAMA 210:2075-2077, 1969;.
15 +
Bolasny BL, Shepard GH, Scott HW:  The hazards of intravenous polyethylene catheters in surgical patients . Surg Gyn Obst 130:342-346, 1970;.
16 +
Ashcraft KW, Leape LL:  Candida sepsis complicating parenteral feeding . JAMA 212:454-456, 1970;.
17 +
Wilmore DW, Dudrick SJ:  An in-line filter for intravenous solutions . Arch Surg 99:462-463, 1969;.
18 +
Scribner BH, Cole JJ, Christopher TG, et al:  Long-term total parenteral nutrition: The concept of an artificial gut . JAMA 212:457-463, 1970;.
19 +
Brescia MJ, Cimino JE, Appel K, et al:  Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula . New Eng J Med 275:1089-1092, 1966;.
20 +
Autian J:  Plastics as a container for parenteral solutions , in. Symposium on Safety of Large Volume Parenteral Solutions, National Symposium Proceedings, US Food and Drug Administration, July 28-29, 1966 , pp 38-47.
21 +
Marcel YL, Noel SP:  Contamination of blood stored in plastic packs . Lancet 1:35-36, 1970;.
22 +
Gesler RM, Kartinos NJ:  Contamination of blood stored in plastic packs . Lancet 1:1227, 1970;.
23 +
Jaeger RJ, Rubin RJ:  Contamination of blood stored in plastic packs . Lancet 2:151, 1970;.
24 +
Jaeger RJ, Rubin RJ:  Plasticizers from plastic devices: Extraction, metabolism and accumulation by biological systems . Science 170:460-462, 1970;.
25 +
Flack HL, Gans JA, Serlick SE, et al:  The current status of parenteral hyperalimentation . Am J Hosp Pharmacy 28:326-335, 1971;.
26 +
Wyrick WJ, Rea WJ, McClelland RN:  Rare complications with intravenous hyperosmotic alimentation . JAMA 211:1697-1698, 1970;.
27 +
Winters RW, Scaglione PR, Nahas GG, et al:  The mechanism of acidosis produced by hyperosmotic infusions . J Clin Invest 43:647-658, 1964;.
28 +
Kaplan MS, Mares A, Quintana P, et al:  High caloric glucose-nitrogen infusions. Postoperative management of neonatal infants . Arch Surg 99:567-571, 1969;.
29 +
Bergström J, Hultman E, Roch-Norlund AE:  Lactic Acid accumulation in connection with fructose infusion . Acta Med Scand 184:359-364, 1968;.
30 +
Schumer W:  High caloric solutions in traumatized patients , in Nahas GG, Fox CL Jr (eds): Body Fluid Replacement in the Surgical Patient . New York, Grune & Stratton Inc, 1970;, pp 326-333.
31 +
Thomas DW, Edwards JB, Edwards RG:  Examination of xylitol . New Eng J Med 283:437, 1970;.
32 +
Schumer W:  Preliminary report: Adverse effects of xylitol in parenteral alimentation . Metabolism 20:345-347, 1971;.
33 +
Young JM, Weser E:  The metabolism of circulating maltose in man . J Clin Invest 50:986-991, 1971;.
34 +
Rubin E, Lieber CS:  Alcoholism, alcohol and drugs . Science 172:1097-1102, 1971;.
35 +
Cahill GF Jr, Felig P, Marliss EB:  Some physiological principles of parenteral nutrition , in Nahas GG, Fox CL Jr (eds): Body Fluid Replacement in the Surgical Patient . New York, Grune & Stratton Inc, 1970;, pp 286-293.
36 +
Kinney JM, Long CI, Duke JH Jr:  Energy demands in the surgical patient , in Nahas GG, Fox CL Jr (eds): Body Fluid Replacement in the Surgical Patient . New York, Grune & Stratton Inc, 1970;, pp 296-300.
37 +
Harper AE:  Amino acid toxicities and imbalances , in Munro HM, Allison JB (eds): Mammalian Protein Metabolism . New York, Academic Press, 1964;, vol 2, pp 87-134.
38 +
Holman RT:  Essential fatty acid deficiency , in Holman RT (ed): Progress in the Chemistry of Fats and Other Lipids . Elmsford, NY, Pergamon Press, 1968;, vol 9, pt (2) , pp 275-348.
39 +
Dudrick SJ, Steiger E, Long JM:  Renal failure in surgical patients treated with intravenous essential amino acids and hypertonic glucose . Surgery 68:180-186, 1970;.
40 +
Allison JB:  Utilization of protein hydrolysates by normal and protein-depleted animals . Am J Med 5:419-432, 1948;.
41 +
Werner SC:  The use of a mixture of pure amino acids in surgical nutrition: II. Effects upon nitrogen balance . Ann Surg 126:175-194, 1947;.
42 +
Moore FD: Metabolic Care of the Surgical Patient . Philadelphia, W.B. Saunders Co, 1959;, p 46.
43 +
Owen OE, Felig P, Morgan AP, et al:  Liver and kidney metabolism during prolonged starvation . J Clin Invest 48:574-583, 1969;.
44 +
National Research Council, Food and Nutrition Board: Recommended Dietary Allowances , ed 7, publication 1694, Washington, DC, National Academy of Sciences, 1968;.
45 +
Shils ME:  Experimental human magnesium depletion . Medicine 48:61-85, 1969;.
46 +
Lotz M, Zisman E, Bartter FC:  Evidence for a phosphorus depletion syndrome in man . New Eng J Med 278:409-415, 1968;.
47 +
Lichtman MA, Miller DR, Cohen J, et al:  Reduced red cell glycolysis, 2,3-diphosphoglycerate and adenosine triphosphate concentration, and increased hemoglobin-oxygen affinity caused by hypophosphatemia . Ann Intern Med 74:562-568, 1971;.
48 +
Travis SF, Sugerman HJ, Ruberg RL, et al:  Alterations of red-cell glycolytic intermediates and oxygen transport as a consequence of hypophosphatemia in patients receiving intravenous hyperalimentation . New Eng J Med 285:763-768, 1971;.
49 +
Miller GH, Vermeulen CW, Moore JD:  Calcium oxalate solubility in urine: Experimental urolithiasis XIV . J Urology 79:607-612, 1958;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Shils ME:  Intravenous feeding—nutritional aspects . Postgrad Med 36:A99-A107, 1964;.
2 +
Dudrick SJ, Wilmore DW, Vars HM, et al:  Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss in an adult? An affirmative answer . Ann Surg 169:974-985, 1969;.
3 +
Filler RM, Eraklis AJ, Rubin VG, et al:  Long-term total parenteral nutrition in infants . New Eng J Med 281:589-594, 1969;.
4 +
Shils ME, Wright WL, Turnbull A, et al:  Long-term parenteral nutrition through an external arteriovenous shunt. Report of a case . New Eng J Med 283:341-344, 1970;.
5 +
Elman R: Parenteral Nutrition in Surgery . New York, Paul B. Hoeber, 1947;, pp 1-13.
6 +
Geyer RP:  Parenteral nutrition . Physiol Rev 40:150-186, 1960;.
7 +
Ellison EH, McCleery RS, Zollinger RM, et al:  The influence of caloric intake upon the fate of parenteral nitrogen . Surgery 26:374-383, 1949;.
8 +
Rice CO, Orr B, Treloar AE, et al:  Parenteral nutrition in surgery . Arch Surg 61:977-991, 1950;.
9 +
Merrill JP: The Treatment of Renal Failure , New York, Grune & Stratton Inc, 1955;, pp 88-89.
10 +
Watkin DM, Steinfeld JL:  Nutrient and energy metabolism in patients with and without cancer during hyperalimentation with fat administered intravenously . Am J Clin Nutr 16:182-212, 1965;.
11 +
Dudrick SJ, Wilmore DW, Vars HM, et al:  Long-term total parenteral nutrition with growth, development and positive nitrogen balance . Surgery 64:134-142, 1968;.
12 +
Wilmore DW, Dudrick SJ:  Safe long-term venous catheterization . Arch Surg 98:256-258, 1969;.
13 +
Atkins RC, Vizzo JE, Cole JJ, et al:  The artificial gut in hospital and home. Technical improvements . Trans Am Soc Artif Int Organs 16:260-266, 1970;.
14 +
Corso JA, Agostinelli R, Brandriss MW:  Maintenance of venous polyethylene catheters to reduce risk of infection . JAMA 210:2075-2077, 1969;.
15 +
Bolasny BL, Shepard GH, Scott HW:  The hazards of intravenous polyethylene catheters in surgical patients . Surg Gyn Obst 130:342-346, 1970;.
16 +
Ashcraft KW, Leape LL:  Candida sepsis complicating parenteral feeding . JAMA 212:454-456, 1970;.
17 +
Wilmore DW, Dudrick SJ:  An in-line filter for intravenous solutions . Arch Surg 99:462-463, 1969;.
18 +
Scribner BH, Cole JJ, Christopher TG, et al:  Long-term total parenteral nutrition: The concept of an artificial gut . JAMA 212:457-463, 1970;.
19 +
Brescia MJ, Cimino JE, Appel K, et al:  Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula . New Eng J Med 275:1089-1092, 1966;.
20 +
Autian J:  Plastics as a container for parenteral solutions , in. Symposium on Safety of Large Volume Parenteral Solutions, National Symposium Proceedings, US Food and Drug Administration, July 28-29, 1966 , pp 38-47.
21 +
Marcel YL, Noel SP:  Contamination of blood stored in plastic packs . Lancet 1:35-36, 1970;.
22 +
Gesler RM, Kartinos NJ:  Contamination of blood stored in plastic packs . Lancet 1:1227, 1970;.
23 +
Jaeger RJ, Rubin RJ:  Contamination of blood stored in plastic packs . Lancet 2:151, 1970;.
24 +
Jaeger RJ, Rubin RJ:  Plasticizers from plastic devices: Extraction, metabolism and accumulation by biological systems . Science 170:460-462, 1970;.
25 +
Flack HL, Gans JA, Serlick SE, et al:  The current status of parenteral hyperalimentation . Am J Hosp Pharmacy 28:326-335, 1971;.
26 +
Wyrick WJ, Rea WJ, McClelland RN:  Rare complications with intravenous hyperosmotic alimentation . JAMA 211:1697-1698, 1970;.
27 +
Winters RW, Scaglione PR, Nahas GG, et al:  The mechanism of acidosis produced by hyperosmotic infusions . J Clin Invest 43:647-658, 1964;.
28 +
Kaplan MS, Mares A, Quintana P, et al:  High caloric glucose-nitrogen infusions. Postoperative management of neonatal infants . Arch Surg 99:567-571, 1969;.
29 +
Bergström J, Hultman E, Roch-Norlund AE:  Lactic Acid accumulation in connection with fructose infusion . Acta Med Scand 184:359-364, 1968;.
30 +
Schumer W:  High caloric solutions in traumatized patients , in Nahas GG, Fox CL Jr (eds): Body Fluid Replacement in the Surgical Patient . New York, Grune & Stratton Inc, 1970;, pp 326-333.
31 +
Thomas DW, Edwards JB, Edwards RG:  Examination of xylitol . New Eng J Med 283:437, 1970;.
32 +
Schumer W:  Preliminary report: Adverse effects of xylitol in parenteral alimentation . Metabolism 20:345-347, 1971;.
33 +
Young JM, Weser E:  The metabolism of circulating maltose in man . J Clin Invest 50:986-991, 1971;.
34 +
Rubin E, Lieber CS:  Alcoholism, alcohol and drugs . Science 172:1097-1102, 1971;.
35 +
Cahill GF Jr, Felig P, Marliss EB:  Some physiological principles of parenteral nutrition , in Nahas GG, Fox CL Jr (eds): Body Fluid Replacement in the Surgical Patient . New York, Grune & Stratton Inc, 1970;, pp 286-293.
36 +
Kinney JM, Long CI, Duke JH Jr:  Energy demands in the surgical patient , in Nahas GG, Fox CL Jr (eds): Body Fluid Replacement in the Surgical Patient . New York, Grune & Stratton Inc, 1970;, pp 296-300.
37 +
Harper AE:  Amino acid toxicities and imbalances , in Munro HM, Allison JB (eds): Mammalian Protein Metabolism . New York, Academic Press, 1964;, vol 2, pp 87-134.
38 +
Holman RT:  Essential fatty acid deficiency , in Holman RT (ed): Progress in the Chemistry of Fats and Other Lipids . Elmsford, NY, Pergamon Press, 1968;, vol 9, pt (2) , pp 275-348.
39 +
Dudrick SJ, Steiger E, Long JM:  Renal failure in surgical patients treated with intravenous essential amino acids and hypertonic glucose . Surgery 68:180-186, 1970;.
40 +
Allison JB:  Utilization of protein hydrolysates by normal and protein-depleted animals . Am J Med 5:419-432, 1948;.
41 +
Werner SC:  The use of a mixture of pure amino acids in surgical nutrition: II. Effects upon nitrogen balance . Ann Surg 126:175-194, 1947;.
42 +
Moore FD: Metabolic Care of the Surgical Patient . Philadelphia, W.B. Saunders Co, 1959;, p 46.
43 +
Owen OE, Felig P, Morgan AP, et al:  Liver and kidney metabolism during prolonged starvation . J Clin Invest 48:574-583, 1969;.
44 +
National Research Council, Food and Nutrition Board: Recommended Dietary Allowances , ed 7, publication 1694, Washington, DC, National Academy of Sciences, 1968;.
45 +
Shils ME:  Experimental human magnesium depletion . Medicine 48:61-85, 1969;.
46 +
Lotz M, Zisman E, Bartter FC:  Evidence for a phosphorus depletion syndrome in man . New Eng J Med 278:409-415, 1968;.
47 +
Lichtman MA, Miller DR, Cohen J, et al:  Reduced red cell glycolysis, 2,3-diphosphoglycerate and adenosine triphosphate concentration, and increased hemoglobin-oxygen affinity caused by hypophosphatemia . Ann Intern Med 74:562-568, 1971;.
48 +
Travis SF, Sugerman HJ, Ruberg RL, et al:  Alterations of red-cell glycolytic intermediates and oxygen transport as a consequence of hypophosphatemia in patients receiving intravenous hyperalimentation . New Eng J Med 285:763-768, 1971;.
49 +
Miller GH, Vermeulen CW, Moore JD:  Calcium oxalate solubility in urine: Experimental urolithiasis XIV . J Urology 79:607-612, 1958;.

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