Which of the following is correct about the initiation of parenteral nutrition?

• A. Indication for PN, central venous access, and a physician-ordered PN regimen.
• B. Only a physician's order is required.
• C. Only central venous access is required.
• D. Only a nutritional assessment is required.

Answer: (A)

Initiation of parenteral nutrition requires three essential elements to be in place: a clear indication for PN, central venous access, and a physician-ordered PN regimen. The indication confirms PN is needed because the patient cannot meet nutritional needs through the GI tract or oral intake. Central venous access is required because PN solutions are highly concentrated and can irritate peripheral veins, so a central catheter ensures safe delivery. The physician must order a PN regimen that specifies the exact composition, including calories, amino acids, lipids, electrolytes, vitamins, and trace elements, along with the rate and fluid limits to ensure safety and effectiveness.

Without any one of these components, PN initiation would be inappropriate or unsafe. An order alone isn’t enough without a stated indication and access; access alone doesn’t start PN without a prescribed regimen; a nutritional assessment alone doesn’t initiate PN because it doesn’t establish the actual therapy plan.