Total Parenteral Nutrition and Intradialytic Parenteral Nutrition

This policy covers total parenteral nutrition (TPN) and intradialytic parenteral nutrition (IDPN) as intravenous nutrition when enteral/oral routes cannot meet needs, including adults and children with documented malnutrition (e.g., ≥10% weight loss in 6 months or pediatric growth percentiles <10th), neonates <1000 g, and conditions such as short bowel syndrome, Crohn’s disease, fistulae, obstructing strictures, motility disorders, necrotizing pancreatitis (adults), necrotizing enterocolitis, and liver failure awaiting transplant. Major limitations require prior failure or intolerance of oral/enteral nutrition, time-limited approvals (initial 3 months, continued up to 6 months with documented benefit), IDPN limited to stage 5 CKD patients on hemodialysis as an alternative to scheduled TPN (not for acute kidney injury), and caution due to catheter infection/thrombosis risk, fluid/electrolyte and metabolic complications, reduced nutrient delivery with IDPN (~70%), and limited evidence or benefit in certain populations (e.g., previously well-nourished children, advanced/unresponsive cancer, non-transplant candidates).