What is Peripheral Parenteral Nutrition (PPN)?

From the Guidelines

Peripheral Parenteral Nutrition (PPN) is a type of nutrition therapy provided through intravenous administration of nutrients, such as amino acids, glucose, lipids, electrolytes, vitamins, and trace elements, via a peripheral intravenous line. This method of nutritional support is used when a patient cannot meet their nutritional needs orally but doesn't require full central venous nutrition. According to the ESPEN guidelines on definitions and terminology of clinical nutrition 1, PPN is a form of parenteral nutrition that can be administered peripherally, as opposed to centrally through a central venous line.

Key Characteristics of PPN

• Delivers a less concentrated solution of nutrients, including dextrose, amino acids, and lipids, along with electrolytes, vitamins, and minerals
• Suitable for short-term use (generally 7-10 days) in patients with functional gastrointestinal tracts who need supplemental nutrition or as a bridge to enteral feeding
• Has lower osmolarity than Total Parenteral Nutrition (TPN), making it less irritating to peripheral veins, though it still carries risks of phlebitis, infiltration, and infection
• Caloric content is typically limited to 2,000-2,400 calories per day due to volume and concentration constraints

Indications for PPN

• Nutritional support is needed for less than two weeks
• The patient has good peripheral venous access
• Their nutritional requirements aren't extremely high As stated in the ESPEN guidelines 1, parenteral nutrition, including PPN, is a type of nutrition therapy provided through intravenous administration of nutrients, with a strong consensus of 97% agreement among experts.

From the Research

Definition and Composition of Peripheral Parenteral Nutrition (PPN)

• Peripheral Parenteral Nutrition (PPN) is a type of parenteral nutrition that is administered through a peripheral vein, as opposed to a central venous catheter 2.
• PPN contains dextrose, amino acids, electrolytes, vitamins, and minerals, but in more limited capacity compared to parenteral nutrition (PN) infused via a central venous catheter 2.
• The composition of PPN is similar to PN, but with a lower nutrient content and larger volume, making it suitable for administration via a peripheral vein 3.

Indications and Uses of PPN

• PPN is intended for short-term use or supplementation, and is often used to maintain a previously well-nourished, non-hypermetabolic patient or as a bridge to centrally administered infusions or enteral feedings 2.
• PPN can be used to provide supplemental protein, energy, and micronutrients to malnourished patients, and can support transition to other modes of nutrition care 4.
• The main indications for PPN include gastrointestinal tract dysfunction and post-surgical status 4.

Safety and Efficacy of PPN

• PPN has been shown to be a safe and effective way to deliver supplemental nutrients to malnourished patients, with minimal complications related to intravenous access 4.
• The use of PPN can help to prevent energy deficits and reduce the risk of undernutrition-related complications in patients with significant energy deficits 5.
• However, PPN may not be suitable for all patients, and the decision to use PPN should be made on a case-by-case basis, taking into account the individual patient's needs and medical status 2, 3, 4.