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Parenteral Nutrition - Methods of Delivery

Parenteral nutrition may be delivered either through ‘multiple bottles’ or ‘all-in-one system’ is the most preferred way of administering Parenteral nutrition where all macro and micronutrients required for 24 hours are infused from one bag. The main advantage here is less handling during preparation and delivery, which means less chances of infection. Reduced cost, better assimilation and utilization of nutrients and fewer chances of metabolic complications are the other advantages of using the ‘all-in-one system’. However, some physicians and surgeons feel more comfortable using a ‘multiple bottle system’ despite the apparent disadvantages. They find this system has the advantage of flexibility and ease of adjustment to the rapidly changing patient needs particularly in critically ill surgical patients. In general, the overall composition of parenteral nutrition is aminoacids as a protein source and glucose along with lipids to provide the adequate non-protein energy. Trace elements, electrolytes and vitamins are often incorporated in the aminoacid solutions to cover the basic daily requirements. However, this fixed composition may not be sufficient and specific vitamins or additional trace elements may need to be supplemented in certain clinical situations (e.g. burns, GI fistulae).