TPN Does NOT cause infection in 2024!- Paul Wischmeyer MD

randomized trials in journals you've heard of jamama Lance at New England Journal in thousands of significantly ill patients that tpn has no association with infection risk in 2022 many many good studies and good journals um and these basically show that it's just as safe to put tpn through a central line as it is sailing through a central line they're equally safe and so why is this well there's a lot of reasons one is we don't hyper alate anymore we we actually now are measuring our patients needs with things like indirect hometry and other measures we control hypoglycemia virtually all the trials that showed a risk of infection with tpn where when we let glucoses range up above what we would ever do now when I was a resident we didn't treat hypoglycemia till the number was above 350 in US units and so now we would never do that and so all these old TVN studies didn't control for hypoglycemia that just started in 2001 and now we give more protein we have better central line care with our checklists and we have better lipids and so we'll talk about that in a moment so even our guidelines have now caught up our 2022 Aspen IU nutrition guidelines say there's no difference in clinical outcomes between early or early PN and they can be used interchangeably and so I think this is essential that we recommend either PN early or E and early is acceptable when we need to deliver nutrition and again the clinical outcomes are the same and this is a strong recommendation so this is a major shift in the Asen guideline