Total parenteral nutrition: a safe procedure in the small community hospital?

The complication rate for all patients receiving total parenteral nutrition (TPN) over a 4-year period of time in a small community hospital has been continuously reviewed. Audit of the complication rate of the initial 15 patients receiving TPN revealed a 12.5% sepsis rate. After instituting rigid protocols concerning catheter insertion and care, a nursing care plan, and metabolic flow sheet, we found that the catheter sepsis rate decreased to 5.1% (P less than 0.05) in the subsequent group of 31 patients. However, metabolic complications related to TPN were not significantly different in the two groups. We conclude that community hospitals without a nutritional team can achieve acceptable complication rates for patients receiving TPN if the staff is committed to continuous critical analysis of complications. Transfer of depleted patients to institutions with demonstrated expertise in this area is recommended if such an analysis shows unacceptable complication rates.