Supplemental, Peripheral, and Central Parenteral Nutrition: Indications, risks, and timing

Getting a head start on nutrition for hospitalized patients can make a big difference when combating malnutrition and critical illness. In this video, Jessica MS, RDN, CNSC, CDN and Kaitlyn MS, RDN, CNSC, CDN discuss the importance of parenteral nutrition including supplemental, peripheral, and central administration. They will also speak to risk mitigation strategies, indications, and timing impacts of early and supplemental PN.

References: Adeyinka A, Rouster AS, Valentine M. Enteral Feeding. [Updated 2022 Dec 26].

StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532876/​

Alfano, J., & Batista, K. (2025). Registered dietitian-led parenteral nutrition order-writing leads to increased usage and decreased errors. Journal of the Academy of Nutrition and Dietetics, 125(10), A15. https://www.jandonline.org/article/S2212-2672(25)00277-1/fulltext ​

Alsharif DJ, et al. Effect of Supplemental Parenteral Nutrition Versus Enteral Nutrition Alone on ​Clinical Outcomes in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2020 Sep 28;12(10):2968. doi: 10.3390/nu12102968. PMID: 32998412; PMCID: PMC7601814.​ ​ Ayers P, et al. A.S.P.E.N. parenteral nutrition safety consensus recommendations. JPEN J Parenter Enteral Nutr. 2014;38(3):296-333. doi:10.1177/0148607113511992​

Ayers et al. Expert consensus statements and summary of proceedings from the International Safety and Quality of Parenteral Nutrition Summit. Am J Health Sys Pharm. 2024;81(3): S75-S88.​

Baik, S. M., et al. (2024). Comparison of Early Enteral Nutrition Versus Early Parenteral Nutrition in Critically Ill Patients: A Systematic Review and Meta-Analysis. Nutrients, 17(1), 10. https://doi.org/10.3390/nu17010010​

Berlana D. (2022). Parenteral Nutrition Overview. Nutrients, 14(21), 4480. https://doi.org/10.3390/nu14214480​

Bidgood et al. Nutr Clin Pract. 2025;40(4): 942-949​

Guenter P, et al. Update on use of enteral and parenteral nutrition in hospitalized patients with a diagnosis of malnutrition in the United States. Nutr Clin Pract. 2022; 37: 94–101. https://doi.org/10.1002/ncp.10827

Haines, K.L., et al. Hospital change to mixed lipid emulsion from soybean oil-based lipid emulsion for parenteral nutrition in hospitalized and critically ill adults improves outcomes: a pre–post-comparative study. Crit Care 26, 317 (2022). https://doi.org/10.1186/s13054-022-04194-8​

Harvey, S. E., Parrott, F., et al. (2014). Trial of the route of early nutritional support in critically ill adults. The New England journal of medicine, 371(18), 1673–1684. https://doi.org/10.1056/NEJMoa1409860​

Martindale, R., et al. (2020). Nutrition Therapy in Critically Ill Patients With Coronavirus Disease 2019. JPEN. Journal of parenteral and enteral nutrition, 44(7), 1174–1184. https://doi.org/10.1002/jpen.1930​

Peterson, S., Dobak, S., et al. (2020). Enteral and parenteral order writing survey - a collaborative evaluation between the Academy of Nutrition and Dietetics’ Dietitians in Nutrition Support Dietetics Practice Group and the American Society for Parenteral and Enteral Nutrition (Aspen) Dietetics Practice section. Nutrition in Clinical Practice, 35(3), 377–385. https://doi.org/10.1002/ncp.10467​

Pharmko The Long-Term Benefits and Risks of Using TPN for Nutritional Support. (2025) https://www.pharmko.com/blog/the-long-term-benefits-and-risks-of-using-tpn-for-nutritional-support​

Reignier, J., et al. Clinical Research in Intensive Care and Sepsis (CRICS) group (2018). Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet (London, England), 391(10116), 133–143. https://doi.org/10.1016/S0140-6736(17)32146-3​ ​ Ridley EJ, Davies AR, et al.; Supplemental Parenteral Nutrition Clinica Investigators. Supplemental parenteral nutrition versus usual care in critically ill adults: a pilot