The first step is to determine the need for TPN. The key question here is - Enteral or Parenteral? Enteral nutrition is clearly superior to parenteral for many reasons. It provides trophic effects on the intestinal mucosa, reduces bacterial translocation and supports gut-associated lymphoid tissue. It also promotes secretory IgA secretion and function. Finally, it is cheaper and has fewer complications. Parenteral nutrition often requires access to a central venous catheter or at the least a centrally placed PICC line. Placement of these catheters is associated with risks. Their continued presence is also associated with infectious risks. Prolonged use of TPN causes cholestasis and fatty infiltration of the liver. Finally, TPN can be complicated by various metabolic complications related to vitamin, mineral or electrolyte deficiencies or excesses. It is important to realize that all of these TPN-related complications are potentially fatal. Do not take lightly the decision to begin TPN on any patient.