Clinical Observations: National Advisory Group's Total Parenteral Nutrition (TPN) Guidelines: Why They Are Needed and Causes for Concern

Abstract

In response to several incidents involving the improper preparation and administration of parenteral nutrition solutions, the American Society for Parenteral and Enteral Nutrition's (A.S.P.E.N.) Board of Directors charged the National Advisory Group to develop guidelines as standards of practice for the safe provision of parenteral nutrition; these guidelines were approved in January 1998. As with all practice guidelines, however, these recommendations are broad in scope and need to be interpreted by practitioners to fit the individual clinical scenario. A review of several cases illustrate that had the guidelines been in existence, potentially life-threatening situations could have been avoided. More recent experiences are also reviewed in which the guidelines were applied, but crucial clinical issues that were not expressly addressed by the guidelines still resulted in opportunities for error. It is important to recognize that clinical guidelines for the safe provision of parenteral nutrition are effective in reducing some but not all sources of potential error.