Consider referring a patient for specialist assessment regarding their need for parenteral nutrition if they are malnourished or at risk of malnutrition and have either inadequate or unsafe oral and/or enteral nutritional intake, or a non-functional, inaccessible, or perforated gastrointestinal tract NICE CG32.
Referral should also be considered if the patient requires parenteral nutrition due to complex needs such as short bowel syndrome, increased stoma losses, or slow growth, which may necessitate long-term parenteral nutrition NICE NG154.
Additionally, if the patient's nutritional requirements cannot be met safely through oral or enteral routes, or if there are complications or uncertainties in management, specialist assessment is indicated NICE CG32.