Type and Prevalence of Adverse Events During the Parenteral Nutrition Cycling Process in Patients Being Prepared for Discharge

Abstract

Background: The mechanism for cycling parenteral nutrition (PN) varies from institution to institution. However, the types and frequency of adverse events (AEs) involved with this process are not well understood. Purpose: To determine the type and prevalence of AE in patients during PN cycling and identify factors associated with the occurrence of AEs. Methods: Patients without severe organ dysfunction or uncontrolled diabetes mellitus scheduled to be discharged on cyclic PN with a goal of 12 hours were eligible. Patients were cycled from 24 to 12 hours over 2 or 3 days based on previously established criteria. Demographic, nutrition, and monitoring data were collected. AEs were documented and graded as mild or serious. Results: Mild AEs occurred in 35 of 38 patients (92.1%) consisting primarily of mild hyperglycemia (86.8%) and tachycardia (29.0%). Serious AEs occurred in 8 of 38 patients (21.1%), including 7 patients (18.4%) with capillary blood glucoses between 255 and 324 mg/dL and 1 (2.6%) with tachypnea/tachycardia requiring immediate medical attention. No significant associations were made between demographic, medical, nutrition, or laboratory factors and serious AEs. No significant differences in demographic information, nutrition information, comorbidities, diet, medications, or composition of PN were found except for lower body weight in unsuccessful cyclers compared with successful cyclers (P = .042). Conclusions: Most patients incur AEs during PN cycling, primarily mild hyperglycemia and tachycardia. These findings suggest patients need to be monitored closely and treated aggressively for complications during PN cycling.