Researchers looked at how often hospitals use a special type of nutrition support called peripheral parenteral nutrition (PPN) – basically liquid nutrition given through an IV – in patients who can’t eat normally. They studied 761 patients over four years and found something concerning: nearly 44% of patients received this treatment even though they could have eaten through their digestive system instead. While PPN can be lifesaving when needed, using it unnecessarily exposed patients to risks like blood clots and vein inflammation. The study suggests that hospitals should have nutrition experts review these decisions to make sure patients only get PPN when they really need it.

The Quick Take

  • What they studied: How often hospitals use a special IV nutrition method (PPN) and whether patients actually need it, plus what side effects happen when it’s used
  • Who participated: 761 hospital patients in Australia over about 4.5 years; about 44% were women, with an average age of 66 years old
  • Key finding: Nearly 44% of patients who received PPN didn’t actually have a medical reason to need it – they could have eaten normally. About 2% developed blood clots in their veins, and less than 1% developed vein inflammation
  • What it means for you: If you’re hospitalized and a doctor suggests PPN, it’s worth asking whether you could eat normally instead. PPN is important when truly needed, but unnecessary use carries real risks. Having a nutrition specialist review the decision could prevent complications

The Research Details

Researchers looked back at pharmacy records from May 2019 through December 2023 at an Australian hospital to find every patient who received PPN. They then reviewed each patient’s medical records to understand why they got PPN, how long they used it, and what happened to them. This type of study is called a ‘cohort study’ because researchers follow a group of people and collect information about what happens to them over time. In this case, they weren’t following people forward – they were looking backward at records that already existed.

The researchers collected information about who the patients were (age, gender), why they were in the hospital, why they received PPN, how long they used it, and whether they had any problems from it. They specifically looked for medical reasons that would make it impossible for patients to eat normally, like a blocked bowel or stomach that wasn’t working properly.

This approach is useful because it shows real-world practice – how doctors actually use PPN in a busy hospital without special oversight. However, because researchers were looking backward at existing records rather than carefully controlling the situation, there’s always a chance some information was missed or recorded differently than it actually happened.

Understanding how PPN is actually used in hospitals matters because it’s an invasive procedure with real risks. When doctors use it appropriately, it saves lives. But when used unnecessarily, it exposes patients to complications without any benefit. This study shows what happens when there’s no specialized nutrition team checking whether PPN is really needed. The findings suggest that having experts review these decisions could prevent unnecessary procedures and keep patients safer.

This study has several strengths: it included a large number of patients (761), covered a long time period (4.5 years), and used actual hospital records rather than relying on memory. However, there are some limitations to keep in mind. The study only looked at one hospital in Australia, so results might be different elsewhere. Researchers relied on what was written in medical records, so if doctors didn’t document their reasons clearly, the researchers might have missed important information. The study also couldn’t prove that PPN caused the complications – only that they happened while patients were using it. Finally, we don’t know if the hospital had any guidelines or training about when to use PPN, which could affect how the results apply to other hospitals.

What the Results Show

Out of 761 patients who received PPN, the typical patient was 66 years old, and about 44% were women. Most patients used PPN for a very short time – the middle value was just 3 days, though some patients used it for up to 20 days. The most common reason patients couldn’t eat normally was a blocked bowel or a stomach that wasn’t working (273 patients). However, the most striking finding was that 334 patients – nearly 44% of everyone who received PPN – had no documented medical reason preventing them from eating normally. This means almost half the patients might not have needed PPN at all.

After doctors stopped giving PPN, most patients switched to eating regular food by mouth within about 3 days. This suggests their digestive systems were working well enough for normal eating, which raises questions about why they needed PPN in the first place. The fact that patients recovered so quickly to normal eating suggests many could have eaten that way from the beginning.

When it comes to complications, the study found that 2% of patients developed thrombophlebitis (inflammation and blood clots in veins where the IV was placed) and 0.8% developed deeper venous thrombosis (blood clots in larger veins). While these percentages might sound small, they represent real harm to real patients – about 15 cases of vein inflammation and 6 cases of serious blood clots among the 761 patients studied.

The study didn’t report many other complications, but the absence of reported complications doesn’t mean they didn’t happen – it might just mean they weren’t documented in the medical records. Other potential risks of PPN that weren’t specifically measured in this study include infection at the IV site, problems with the IV line itself, and metabolic complications from the nutrition solution. The study also didn’t measure whether patients who received unnecessary PPN had longer hospital stays or higher costs, which could be important for understanding the full impact of inappropriate use.

Previous research has shown that enteral nutrition (feeding through a tube into the stomach or intestines) is generally safer and better for patients than parenteral nutrition (IV nutrition). This study supports that finding by showing that most patients who received PPN could have eaten normally within a few days. The high rate of inappropriate PPN use (44%) is concerning and suggests this might be a widespread problem in hospitals. Other studies have shown that having a dedicated nutrition support team reduces inappropriate nutrition support, which aligns with this study’s conclusion that such teams are important.

This study only looked at one hospital in Australia, so we can’t be sure the same patterns happen everywhere. The researchers depended on what doctors wrote in medical records – if a doctor had a good reason for PPN but didn’t write it down, the researchers wouldn’t know about it. The study couldn’t prove that PPN caused the blood clots and vein inflammation – only that these problems occurred while patients were using PPN. We don’t know how many patients might have had complications that weren’t noticed or recorded. The study also didn’t compare this hospital to hospitals with nutrition support teams, so we can’t be certain that having such teams would actually reduce inappropriate use. Finally, the study didn’t look at whether certain types of patients or certain doctors were more likely to use PPN inappropriately.

The Bottom Line

Based on this research, hospitals should establish or strengthen nutrition support teams to review PPN prescriptions before they’re given (HIGH confidence). Doctors should try feeding patients through their digestive system first whenever possible, and only use PPN when there’s a clear medical reason (HIGH confidence). Patients and families should feel comfortable asking doctors why PPN is needed and whether eating normally is possible (MODERATE confidence). Hospitals should track complications from PPN and review cases where it was used without clear medical reasons (MODERATE confidence).

Hospital administrators and doctors should care most about this research, as it directly affects how they manage patient care. Patients who are hospitalized and unable to eat should care because it affects their treatment decisions. Family members of hospitalized patients should care because they can advocate for their loved ones. Insurance companies and healthcare policymakers should care because unnecessary procedures increase costs and patient risk. People with conditions that might require nutrition support (like cancer, bowel disease, or difficulty swallowing) should be aware of this research for future reference.

If PPN is truly needed, patients should start feeling better within days as their nutrition improves. However, if PPN was unnecessary, the benefit of stopping it is immediate – removing the risk of complications. Most patients in this study switched to normal eating within 3 days of stopping PPN, suggesting that if someone can eat normally, they should see improvement quickly. Changes from implementing nutrition support teams would take longer – probably weeks to months – as hospitals develop new procedures and train staff.

Want to Apply This Research?

  • If hospitalized, track daily: (1) whether you’re able to eat by mouth, (2) any symptoms like arm swelling, warmth, or redness at IV sites, and (3) what nutrition method you’re using. Share this information with your care team to help them decide if PPN is still needed.
  • Ask your doctor daily: ‘Can I try eating by mouth today?’ or ‘Why do I still need this IV nutrition?’ Document their answers. If you notice swelling, warmth, or pain around your IV site, report it immediately. Request a nutrition specialist review if you’re on PPN for more than a few days.
  • Keep a simple hospital log noting: date, nutrition method used (PPN or eating by mouth), any symptoms at IV sites, and what your doctor said about your nutrition plan. After discharge, follow up with your doctor about nutrition if you had PPN, especially if you had any complications. If you have ongoing digestive issues, ask for a referral to a nutrition specialist.

This research describes patterns at one hospital and should not be used to make individual medical decisions. PPN is a necessary and lifesaving treatment for many patients with serious conditions. If your doctor recommends PPN, discuss with them why it’s needed and whether alternatives are possible. Do not stop or refuse PPN without medical guidance. This article is for educational purposes and is not a substitute for professional medical advice. Always consult with your healthcare team about your specific situation.