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 Parenteral nutrition needs to be infused via a secure central venous access. This avoids complications of phlebitis and injury from extravasation. To minimize infections we recommend maintaining one port dedicated to TPN infusion.

 The total volume of TPN solution is infused at a fixed rate over a 24 hour period. In patients with severe cholestasis or hepatic dysfunction, TPN can be cycled over 12 hours instead.

 While initiating TPN it is important to begin with a half strength solution to minimize complications such as electrolyte derangements, hyperglycemia, and refeeding syndrome. The solution can be advanced over 1–3 days if monitoring panels remain stable.

 While weaning patients off TPN, the caloric strength of the solution should be reduced slowly by 50% before discontinuing the TPN completely.