1
|
Osland EJ, Bhatt S, Nelms M, Pateman K. Oral health access and self-reported outcomes in patients with chronic intestinal failure requiring home intravenous support. Nutr Clin Pract 2024. [PMID: 39101310 DOI: 10.1002/ncp.11196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Patients with chronic intestinal failure (CIF) may be predisposed to poor oral health outcomes. This study explored the self-reported oral health status, function, and psychological impacts of oral health of adult patients with CIF, their access to dental care, and how these compare with the broader population. METHODS All patients >18 years old receiving home intravenous therapies for CIF were invited to complete a self-reported questionnaire providing information on oral health status and access to oral health services. Collateral information was provided by treating clinicians. Descriptive data analysis was undertaken, including subgroup analysis of clinical characteristics, and was compared with the available population-level data. RESULTS Twenty-four patients participated. Short gut and dysmotility accounted for 88% of the etiologies of CIF. Respondents reported good preventative oral health behaviors (96%), accessing dental care within the last 12 months (75%), and limited barriers to receiving care. Dry mouth (96%), oral pain (59%), and temperature sensitivity (60%) were commonly reported across the cohort. Smoking history and reduced oral diet were associated with significantly worse self-reported oral health outcomes. Patients with CIF reported worse oral health outcomes despites better oral health access than the general population. CONCLUSION Patients with CIF appear to be at risk of poor oral health outcomes, especially where smoking or reduced oral intake are concurrently involved. Clinicians involved in CIF care should be alert to the oral health needs of this population and consider oral and dental health as part of the multidisciplinary care required for optimal CIF care.
Collapse
Affiliation(s)
- Emma J Osland
- Department of Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Department of Human Movements and Nutrition, University of Queensland, Brisbane, Queensland, Australia
| | - Swati Bhatt
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Melanie Nelms
- Department of Gastroenterology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kelsey Pateman
- Allied Health Professions, Royal Brisbane and Women's Hospital, Metro North Health, Herston, Queensland, Australia
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| |
Collapse
|
2
|
Wong D, Osland E, Carey S. Funding and resource availability for home parenteral nutrition in Australia: A national cross-sectional survey. JPEN J Parenter Enteral Nutr 2024; 48:693-699. [PMID: 38850512 DOI: 10.1002/jpen.2656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/11/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is a life-saving therapy required for the management of type III intestinal failure, one of the rarest organ failures. It requires a multidisciplinary approach to manage the complexity of the underlying medical, surgical, and nutrition issues, but the current levels of healthcare funding in Australia are unknown. This study aimed to quantify the caseload, staffing, and capacity of existing HPN centers nationally. METHODS This was a cross-sectional survey inviting centers known to provide HPN care. The survey was designed to capture metrics related to the national framework for the delivery of HPN. These centered on staffing levels, patient load, capacity to audit key outcomes, and service challenges. RESULTS A total of 24 (89%) of 27 invited centers responded to the survey. There were 17 (71%) adult centers and 7 (29%) pediatric centers. Adult centers managed a median of 12 (interquartile range [IQR]: 6-25) patients vs 16 (IQR: 9-17) in pediatric centers. Several centers did not have dedicated funding for core team members. The total funded clinician time each week per patient was 7 min (IQR: 0-12 min) in adult centers and 14 min (IQR: 10-21 min) in pediatric centers. Fewer than half of centers reported having sufficient resources to regularly audit key metrics. CONCLUSION The availability of dedicated expertise to manage the highly complex needs of people living with type III intestinal failure is lacking in Australia. Current funding of HPN services falls well short of being sufficient to meet the requirements outlined in the national quality framework.
Collapse
Affiliation(s)
- Darren Wong
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Emma Osland
- Department of Dietetics and Foodservices, Royal Brisbane and Woman's Hospital, Brisbane, Queensland, Australia
- School of Human Movement and Nutrition Studies, University of Queensland, St Lucia, Queensland, Australia
| | - Sharon Carey
- Nutrition and Dietetics Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Baker M, French C, Hann M, Lal S, Burden S. A scoping review of parenteral requirements (macronutrients, fluid, electrolytes and micronutrients) in adults with chronic intestinal failure receiving home parenteral nutrition. J Hum Nutr Diet 2024; 37:788-803. [PMID: 38409860 DOI: 10.1111/jhn.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Home parenteral nutrition (HPN) prescriptions should be individualised in adults with chronic intestinal failure (IF). The aims of the review were to explore HPN requirements and available guidelines and to determine whether adults (≥ 18 years) receive recommended parenteral nutrient doses. METHODS Online databases searches identified empirical evidence (excluding case-reports), reviews and guidelines (Published 2006-2024 in English language). Additional reference lists were hand-searched. Older studies, cited in national guidelines were highlighted to map evidence source. Two reviewers screened 1660 articles independently, with 98 full articles assessed and 78 articles included (of which 35 were clinical studies). Citation tracking identified 12 older studies. RESULTS A lack of evidence was found assessing parenteral macronutrient (amounts and ratios to meet energy needs), fluid and electrolyte requirements. For micronutrients, 20 case series reported serum levels as biomarkers of adequacy (36 individual micronutrient levels reported). Studies reported levels below (27 out of 33) and above (24 out of 26) reference ranges for single micronutrients, with associated factors explored in 11 studies. Guidelines stated recommended parenteral dosages. Twenty-four studies reported variable proportions of participants receiving HPN dosages outside of guideline recommendations. When associated factors were assessed, two studies showed nutrient variation with type of HPN administered (multichamber or individually compounded bags). Five studies considered pathophysiological IF classification, with patients with short bowel more likely to require individualised HPN and more fluid and sodium. CONCLUSIONS This review highlights substantial evidence gaps in our understanding of the parenteral nutritional requirements of adult receiving HPN. The conclusions drawn were limited by temporal bias, small samples sizes, and poor reporting of confounders and dose. Optimal HPN nutrient dose still need to be determined to aid clinical decision-making and further research should explore characteristics influencing HPN prescribing to refine dosing recommendations.
Collapse
Affiliation(s)
- Melanie Baker
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Chloe French
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Mark Hann
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Simon Lal
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- Salford Royal Hospital, Northern Care Alliance NHS Trust, Manchester, UK
| | - Sorrel Burden
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- Salford Royal Hospital, Northern Care Alliance NHS Trust, Manchester, UK
| |
Collapse
|
4
|
Pironi L, Cuerda C, Jeppesen PB, Joly F, Jonkers C, Krznarić Ž, Lal S, Lamprecht G, Lichota M, Mundi MS, Schneider SM, Szczepanek K, Van Gossum A, Wanten G, Wheatley C, Weimann A. ESPEN guideline on chronic intestinal failure in adults - Update 2023. Clin Nutr 2023; 42:1940-2021. [PMID: 37639741 DOI: 10.1016/j.clnu.2023.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND & AIMS In 2016, ESPEN published the guideline for Chronic Intestinal Failure (CIF) in adults. An updated version of ESPEN guidelines on CIF due to benign disease in adults was devised in order to incorporate new evidence since the publication of the previous ESPEN guidelines. METHODS The grading system of the Scottish Intercollegiate Guidelines Network (SIGN) was used to grade the literature. Recommendations were graded according to the levels of evidence available as A (strong), B (conditional), 0 (weak) and Good practice points (GPP). The recommendations of the 2016 guideline (graded using the GRADE system) which were still valid, because no studies supporting an update were retrieved, were reworded and re-graded accordingly. RESULTS The recommendations of the 2016 guideline were reviewed, particularly focusing on definitions, and new chapters were included to devise recommendations on IF centers, chronic enterocutaneous fistulas, costs of IF, caring for CIF patients during pregnancy, transition of patients from pediatric to adult centers. The new guideline consist of 149 recommendations and 16 statements which were voted for consensus by ESPEN members, online in July 2022 and at conference during the annual Congress in September 2022. The Grade of recommendation is GPP for 96 (64.4%) of the recommendations, 0 for 29 (19.5%), B for 19 (12.7%), and A for only five (3.4%). The grade of consensus is "strong consensus" for 148 (99.3%) and "consensus" for one (0.7%) recommendation. The grade of consensus for the statements is "strong consensus" for 14 (87.5%) and "consensus" for two (12.5%). CONCLUSIONS It is confirmed that CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for the underlying gastrointestinal disease and to provide HPN support. Most of the recommendations were graded as GPP, but almost all received a strong consensus.
Collapse
Affiliation(s)
- Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Center for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Francisca Joly
- Center for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Cora Jonkers
- Nutrition Support Team, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Željko Krznarić
- Center of Clinical Nutrition, Department of Medicine, University Hospital Center, Zagreb, Croatia
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | | | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), United Kingdom
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
| |
Collapse
|
5
|
Stevens P. 25 year experience of patterns of plasma vitamin C levels in patients requiring home parenteral support. Clin Nutr ESPEN 2023; 57:106-116. [PMID: 37739644 DOI: 10.1016/j.clnesp.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Vitamin C deficiency is common in patients with chronic intestinal failure. Risk factors are poorly understood and guidelines for monitoring largely based on expert opinion. The aim of this study was to describe patterns of vitamin C deficiency in patients on long-term home parenteral support (HPS). DESIGN A retrospective review of a prospectively collated database for 236 HPS patients cared for in Glasgow, from 1998 to 2023, was interrogated for subjects with paired CRP and vitamin C measurements. Following analysis of the impact of CRP on vitamin C levels, further review of associated clinical, micronutrient and dietetic details in those with a paired CRP <5 mg L-1 were used to identify risk factors for hypoascorbataemia. RESULTS 1527 recorded episodes with paired CRP and vitamin C measurements were analysed. Period prevalence of hypoascorbataemia was between 29.3 and 52.5%, depending on choice of the lower reference range for vitamin C as either 15 μmol L-1 or 26.1 μmol L-1. The influence of CRP appeared most significant early during HPS with other factors, including extensive mucosal disease, precedent surgery or presence of a colostomy identified as more significant on multivariate analysis for those on long-term HPS (OR 1.3261-1.5609, 1.0752-1.1008, and 0.6260-0.6663 for threshold vitamin C of 26.1 or 15 μmol L-1 respectively). CONCLUSION Vitamin C may present differently in long term HPS patients in comparison to those in the acute phase of illness. An evidence based approach to guideline development should be promoted to reduce morbidity.
Collapse
|
6
|
Rosseel Z, Cortoos PJ, De Waele E. Energy Guidance Using Indirect Calorimetry for Intestinal Failure Patients with Home Parenteral Nutrition: The Right Bag Right at the Start. Nutrients 2023; 15:nu15061464. [PMID: 36986194 PMCID: PMC10051893 DOI: 10.3390/nu15061464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Intestinal failure is defined as the inability to absorb the minimum of macro and micronutrients, minerals and vitamins due to a reduction in gut function. In a subpopulation of patients with a dysfunctional gastrointestinal system, treatment with total or supplemental parenteral nutrition is required. The golden standard for the determination of energy expenditure is indirect calorimetry. This method enables an individualized nutritional treatment based on measurements instead of equations or body weight calculations. The possible use and advantages of this technology in a home PN setting need critical evaluation. For this narrative review, a bibliographic search is performed in PubMed and Web of Science using the following terms: 'indirect calorimetry', 'home parenteral nutrition', 'intestinal failure', 'parenteral nutrition', 'resting energy expenditure', 'energy expenditure' and 'science implementation'. The use of IC is widely embedded in the hospital setting but more research is necessary to investigate the role of IC in a home setting and especially in IF patients. It is important that scientific output is generated in order to improve patients' outcome and develop nutritional care paths.
Collapse
Affiliation(s)
- Zenzi Rosseel
- Department of Pharmacy, Universitair Ziekenhuis Brussel (UZB), 1090 Brussels, Belgium
- Department of Clinical Nutrition, Universitair Ziekenhuis Brussel (UZB), 1090 Brussels, Belgium
| | - Pieter-Jan Cortoos
- Department of Pharmacy, Universitair Ziekenhuis Brussel (UZB), 1090 Brussels, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Elisabeth De Waele
- Department of Clinical Nutrition, Universitair Ziekenhuis Brussel (UZB), 1090 Brussels, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Department of Intensive Care, Universitair Ziekenhuis Brussel (UZB), 1090 Brussels, Belgium
| |
Collapse
|
7
|
Pironi L, Boeykens K, Bozzetti F, Joly F, Klek S, Lal S, Lichota M, Mühlebach S, Van Gossum A, Wanten G, Wheatley C, Bischoff SC. ESPEN practical guideline: Home parenteral nutrition. Clin Nutr 2023; 42:411-430. [PMID: 36796121 DOI: 10.1016/j.clnu.2022.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023]
Abstract
This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion catheter and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN.
Collapse
Affiliation(s)
- Loris Pironi
- University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS AOUBO, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Italy.
| | - Kurt Boeykens
- Vitaz Hospital, Nutrition Support Team, Sint-Niklaas, Belgium
| | | | - Francisca Joly
- Beaujon Hospital, APHP, University of Paris VII, Clichy, France
| | - Stanislaw Klek
- Surgical Oncology Clinic, The Maria Sklodowska-Curie National Cancer Institute, Krakow, Poland
| | - Simon Lal
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Stefan Mühlebach
- Division of Clinical Pharmacy and Epidemiology and Hospital Pharmacy, University of Basel, Basel, Switzerland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), UK
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| |
Collapse
|
8
|
Rothkopf M, Pant M, Brown R, Haselhorst J, Gagliardotto F, Tallman A, Stevenson D, DePalma A, Saracco M, Rosenberg D, Proudan V, Shareef K, Ayub N. Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition. BMJ Nutr Prev Health 2022; 5:286-296. [PMID: 36619321 PMCID: PMC9813622 DOI: 10.1136/bmjnph-2022-000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Home parenteral nutrition (HPN) is essential for patients with intestinal failure requiring long-term nutritional support. The Amerita Quality Improvement Project for HPN Patients (QIP-PN) explored the effect of a physician nutrition expert (PNE)-led multidisciplinary nutritional support team (MNST) on HPN care for patients under its service. Objective To determine an MNST effect on adherence to protocols, outcomes and quality of life (QOL) in HPN. Methods The study was divided into three phases: data review (phases 1a and 1b), observation (phase 2) and intervention (phase 3). Seven Amerita locations were selected as 'study branches' (population), from which all study patients and controls were drawn. The quality improvement project employed a quasi-experimental case-matched control group (control) design. Data were collected on demographics, treating physicians PNE status, HPN care variables, recommended interventions, quality-of-life assessment, adverse outcomes and hospitalisations. Paired t-test compared continuous data between phases 2 and 3. Comparisons between study and control groups used a negative binomial regression model. Results Thirty-four patients were reviewed in phase 1a and 197 in phase 1b. Forty study patients completed phase 2 and progressed into phase 3, of whom 30 completed ≥60 therapy days. Patients were lost to follow-up if they discontinued HPN for any reason. Improvements in weight, body mass index and QOL were seen in the study patients during intervention. Recommendations made and accepted by treating physicians differed based on PNE status. Study patients had fewer adverse outcomes and related hospitalisations than controls. Conclusion MNST recommendations improved clinical, biochemical parameters and patients' self-reported overall health. MNST input reduced adverse outcomes, hospitalisation and the length of stay at the hospital. This study highlights the potential for MNST to have a significant impact on the quality and overall cost of HPN management.
Collapse
Affiliation(s)
- Michael Rothkopf
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mohan Pant
- School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | | | | | | | | | | | | | | | | | | | | | - Nudrat Ayub
- Atlantic Health System Inc, Florham Park, New Jersey, USA
| |
Collapse
|
9
|
Alabbas F, Dumant C. Outcomes of Blenderized Gastrostomy Feeding in Children at Rouen University Hospital. Pediatric Health Med Ther 2022; 13:271-277. [PMID: 35983160 PMCID: PMC9379119 DOI: 10.2147/phmt.s361724] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Faisal Alabbas
- Pediatric Department, Rouen University Hospital, Rouen, France
- Pediatric Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
- Correspondence: Faisal Alabbas, Pediatric Department, King Abdulaziz University Hospital, Abdullah Sulayman Street, Jeddah, 22245, Saudi Arabia, Email
| | | |
Collapse
|
10
|
Blenderised Tube Feeds vs. Commercial Formula: Which Is Better for Gastrostomy-Fed Children? Nutrients 2022; 14:nu14153139. [PMID: 35956316 PMCID: PMC9370549 DOI: 10.3390/nu14153139] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Blenderised tube feeds (BTF) have become a popular alternative to commercial formula (CF) for enterally fed children. This study sought to compare gastrointestinal (GI) symptoms, GI inflammation, and stool microbiome composition between children receiving BTF or CF. This prospective cohort study involved 41 gastrostomy-fed children, aged 2–18 years, receiving either BTF (n = 21) or CF (n = 20). The Paediatric Quality of Life Inventory Gastrointestinal Symptoms Scale (GI-PedsQL) was used to compare GI symptoms between the groups. Anthropometric data, nutritional intake, nutritional blood markers, faecal calprotectin levels, stool microbiota, and parental satisfaction with feeding regimen were also assessed. Caregivers of children on BTF reported greater GI-PedsQL scores indicating significantly fewer GI symptoms (74.7 vs. 50.125, p = 0.004). Faecal calprotectin levels were significantly lower for children receiving BTF compared to children on CF (33.3 mg/kg vs. 72.3 mg/kg, p = 0.043) and the BTF group had healthier, more diverse gut microbiota. Subgroup analysis found that 25% of caloric intake from BTF was sufficient to improve GI symptoms. The CF group had better body mass index (BMI) z-scores (−0.7 vs. 0.5, p = 0.040). Although growth was poorer in children receiving only BTF in comparison to the CF group, this was not seen in children receiving partial BTF. A combination of BTF and CF use may minimise symptoms of tube feeding whilst supporting growth.
Collapse
|
11
|
Slye K, McKiernan M, Griffin A, Cremona A. A comparison of a home parenteral nutrition service with the current European (ESPEN) guidelines on chronic intestinal failure in adults. Clin Nutr ESPEN 2022; 50:289-306. [DOI: 10.1016/j.clnesp.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
|
12
|
Berger MM, Pichard C. When is parenteral nutrition indicated? JOURNAL OF INTENSIVE MEDICINE 2022; 2:22-28. [PMID: 36789227 PMCID: PMC9923955 DOI: 10.1016/j.jointm.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 02/07/2023]
Abstract
The indications and contraindications of parenteral nutrition (PN) are discussed in view of recent clinical findings. For decades, PN has been restricted to patients unable to tolerate enteral nutrition (EN) intake owing to the perceived risk of severe side-effects. The evolution of the PN substrate composition and delivery of nutrition via all-in-one bags has dramatically improved the application prospects of PN. Recent studies show similar complication rates of nutrition therapy administered through enteral and intravenous routes. Therefore, indications of PN have, based on evidence, extended beyond complete gastrointestinal (GI) failure to include conditions such as insufficient EN generating persistent negative energy balance and insufficient protein intakes, malabsorption, or specific needs that are impossible to cover with EN feeds.
Collapse
Affiliation(s)
- Mette M. Berger
- Adult Intensive Care, Lausanne University Hospital, Lausanne 1011, Switzerland,Corresponding author: Mette M. Berger, Adult Intensive Care, Lausanne University Hospital, Lausanne 1011, Switzerland. E-mail address: .
| | - Claude Pichard
- Clinical Nutrition, Geneva University Hospital, Geneva 1203, Switzerland
| |
Collapse
|
13
|
Gillis VE, van Houdt T, Wouters Y, Wanten GJ. Anticoagulants decrease the risk for catheter-related venous thrombosis in patients with chronic intestinal failure: A long-term cohort study. JPEN J Parenter Enteral Nutr 2021; 46:1677-1685. [PMID: 34967025 PMCID: PMC9542651 DOI: 10.1002/jpen.2323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Catheter-related venous thrombosis (CRVT) is a severe complication of home parental nutrition (HPN). Although primary prevention of CRVT is crucial, there is no consensus on anticoagulant use to prevent this adversity. Aim of this study was to compare CRVT risk in chronic intestinal failure (CIF) patients in the presence or absence of anticoagulants, and to identify CRVT risk factors . METHODS This retrospective cohort study comprised adult CIF patients with a central venous access device (CVAD) between 2010 and 2020 who were treated at our national CIF referral center. Analyses were performed at CVAD level. Primary outcome was the CRVT risk of CIF patients using anticoagulants compared to those without anticoagulants. RESULTS Overall, 1188 CVADs in 389 patients were included (540.800 CVAD days). Anticoagulants were used in 403 CVADs. In total, 137 CRVTs occurred in 98 patients, resulting in 0.25 CRVTs/1000 CVAD days (95%CI 0.22-0.29). Anticoagulant use was associated with a decreased CRVT risk (OR 0.53 95%CI 0.31-0.89; P = 0.02). Left-sided CVAD insertion (OR 2.00 95%CI 1.36-2.94), a history of venous thrombosis (OR 1.73 95%CI 1.05-2.84), and a shorter period post-insertion (OR 0.78 95%CI 0.65-0.92) were independently associated with an increased CRVT risk. CONCLUSION Anticoagulants decreased the CRVT risk. In addition, we identified left-sided vein insertion, a history of venous thrombosis, and a shorter period post CVAD insertion as CRVT risk factors. Further prospective studies should provide guidance whether prophylactic anticoagulant use, especially in higher-risk patients with a left-sided CVAD or a history of venous thrombosis, is justified. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Veerle Elm Gillis
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thijs van Houdt
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yannick Wouters
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert Ja Wanten
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
14
|
Hardy G, Austin PD, Davis MR, Manzanares W, Mühlebach SF, Pietka M, Allwood MC. Photoprotection of parenteral nutrition: an international perspective. Nutr Clin Pract 2021; 36:921-925. [PMID: 34494687 DOI: 10.1002/ncp.10773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | - Peter D Austin
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust and University College, London, UK
| | | | - William Manzanares
- Department of Critical Care, University Hospital, Faculty of Medicine, Universidad de la República UdelaR, Uruguay
| | - Stefan F Mühlebach
- Department of Pharmaceutical Sciences, Division of Clinical Pharmacy & Epidemiology/Hospital Pharmacy, University of Basel, Switzerland
| | - Magdalena Pietka
- Pharmacy Department, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Michael C Allwood
- Biopharma Stability Testing Laboratory, BioCity Nottingham, Nottingham, UK
| |
Collapse
|
15
|
Cuerda C, Pironi L, Arends J, Bozzetti F, Gillanders L, Jeppesen PB, Joly F, Kelly D, Lal S, Staun M, Szczepanek K, Van Gossum A, Wanten G, Schneider SM, Bischoff SC. ESPEN practical guideline: Clinical nutrition in chronic intestinal failure. Clin Nutr 2021; 40:5196-5220. [PMID: 34479179 DOI: 10.1016/j.clnu.2021.07.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This practical guideline is based on the ESPEN Guidelines on Chronic Intestinal Failure in Adults. METHODOLOGY ESPEN guidelines have been shortened and transformed into flow charts for easier use in clinical practice. The practical guideline is dedicated to all professionals including physicians, dieticians, nutritionists, and nurses working with patients with chronic intestinal failure. RESULTS This practical guideline consists of 112 recommendations with short commentaries for the management and treatment of benign chronic intestinal failure, including home parenteral nutrition and its complications, intestinal rehabilitation, and intestinal transplantation. CONCLUSION This practical guideline gives guidance to health care providers involved in the management of patients with chronic intestinal failure.
Collapse
Affiliation(s)
- Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Loris Pironi
- Alma Mater Studiorum - University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Italy
| | - Jann Arends
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | | | - Lyn Gillanders
- Emeritus of Auckland City Hospital, Auckland, New Zealand
| | - Palle Bekker Jeppesen
- Rigshospitalet, Department of Intestinal Failure and Liver Diseases Gastroenterology, Copenhagen, Denmark
| | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Darlene Kelly
- Emeritus of Mayo Graduate School of Medicine, Rochester, Minnesota
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - Michael Staun
- Rigshospitalet, Department of Intestinal Failure and Liver Diseases Gastroenterology, Copenhagen, Denmark
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - André Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Stéphane Michel Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France
| | - Stephan C Bischoff
- Department of Nutritional Medicine and Prevention, University of Hohenheim, Stuttgart, Germany
| | | |
Collapse
|
16
|
Siu AHY, Carey S, Jones L, Morton RL, Koh CE. Detailed analysis of in-hospital costs for adult patients with type III intestinal failure: A single-center study with global implications. JPEN J Parenter Enteral Nutr 2021; 46:685-692. [PMID: 33929048 DOI: 10.1002/jpen.2136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is the recommended treatment for patients with type III intestinal failure (IF). However, owing to IF's rarity, the economic cost of managing these patients is not well understood. These patients often develop complications resulting in readmissions, which in turn contribute to ongoing costs. This study aims to document the costs of type III IF within the hospital, from initial admission, including readmissions, and to compare incurred costs with current government reimbursement. METHODS A retrospective study design reviewed costs and reimbursement for 25 consecutive patients commencing HPN at a quaternary hospital (October 2011 to September 2017). Hospital admissions were separated into the initial admission and readmission(s) period. Healthcare use and cost data were collected using electronic medical records. Hospital reimbursement costs were retrieved from Sydney Local Health District's Targeted Activity and Reporting Systems. Patient demographics were tabulated, and healthcare use and cost data were compared using Wilcoxon signed rank tests. RESULTS The median cost of the initial hospital admission was substantially higher than the median reimbursement ($36,675; interquartile range [IQR], $23,196-$67,439 vs $19,247; IQR, $7485-$41,090; P < .001). Similar results were observed in the readmissions period, with median incurred costs of $13,898; (IQR, $11,151-$32,130) vs reimbursement of $8469 (IQR, $5625-$13,078) (P = .001). CONCLUSION Results indicate that type III IF patients have high inpatient costs, which substantially outweigh current reimbursement. Improved funding models are needed to ensure hospitals that accept the management challenge of type III IF patients are not unduly penalized.
Collapse
Affiliation(s)
- Adrian H Y Siu
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.,Graduate School of Medicine, University of Wollongong, NSW, Australia
| | - Sharon Carey
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.,Department of Dietetics and Nutrition, Royal Prince Alfred Hospital, Sydney, Australia.,School of Life and Environmental Sciences, University of Sydney, Sydney, Australia.,Intestinal Failure and Home Parenteral Nutrition Service, Royal Prince Alfred Hospital, Sydney, Australia
| | - Lynn Jones
- Intestinal Failure and Home Parenteral Nutrition Service, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Cherry E Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.,Intestinal Failure and Home Parenteral Nutrition Service, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Discipline of Surgery, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
17
|
Daoud DC, Cartagena EMS, Schwenger KJP, Somlaw N, Gramlich L, Whittaker S, Armstrong D, Jurewitsch B, Raman M, Duerksen DR, McHattie JD, Allard JP. Home parenteral nutrition in older vs younger patients: Clinical characteristics and outcomes. JPEN J Parenter Enteral Nutr 2021; 46:348-356. [PMID: 33811677 DOI: 10.1002/jpen.2117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a demographic shift toward older patients receiving home parenteral nutrition (HPN), but data on clinical outcomes are limited. The objective of this study was to determine differences between older and younger HPN patients in regard to HPN indications, prescriptions, and outcomes over the first 2 years receiving HPN. METHODS This was a retrospective analysis of prospectively collected data from HPN adult patients entered in the Canadian HPN Registry. New HPN patients enrolled between 2003 and 2017 and receiving HPN for at least 2 years were selected. Data included demographics, PN prescriptions, catheter-related bloodstream infections (CRBSIs) over the past year, survival, and quality of life based on Karnofsky Performance Status (KPS). RESULTS Four hundred two patients were included: 184 patients were ≥60 years old, and 219 patients were between 18 and 59 years old. There were no differences in the main indications for HPN, body mass index (BMI), and PN prescriptions at baseline. At 2 years, younger patients received more energy from PN than older patients (27.9 vs 19.6 kcal/kg; P < .001), but BMI remained comparable. There were fewer CRBSIs in the older group (20% vs 36%, P = .0023), but 78% of younger patients remained alive vs 69% in the older group (P = .0401). In those alive, the proportion of patients continuing to receive HPN was comparable and the proportion of patients with a KPS ≥60. CONCLUSIONS Older HPN patients have similar clinical characteristics as younger patients but have fewer CRBSIs and higher 2-year mortality.
Collapse
Affiliation(s)
- Dane Christina Daoud
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Elena M S Cartagena
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Katherine J P Schwenger
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicha Somlaw
- Department of Medicine, The Thai Red Cross Society, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Whittaker
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Armstrong
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Brian Jurewitsch
- Department of Pharmacy, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matreyi Raman
- Division of Gastroenterology and Hepatology, University of Calgary, Alberta, Canada
| | - Donald R Duerksen
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Johane P Allard
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
18
|
Chandrasekar N, Dehlsen K, Leach ST, Krishnan U. Exploring Clinical Outcomes and Feasibility of Blended Tube Feeds in Children. JPEN J Parenter Enteral Nutr 2021; 45:685-698. [PMID: 33305384 DOI: 10.1002/jpen.2062] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
Commercially produced complete nutritional formulas (CFs) are commonly delivered to children requiring enteral nutrition via gastrostomy. However, a cultural shift toward consuming a more natural diet consisting of whole foods has caused the use of blenderized tube feeds (BTFs) to grow in popularity among parents and carers in recent years. There are advantages and disadvantages of both BTF and CF use. There is evidence that suggests that BTFs can significantly improve tube-feeding tolerance and reduce gastrointestinal symptoms associated with tube feeding, such as gagging, retching, and constipation, thereby resulting in an improved quality of life (QoL) for enterally fed children and their caregivers. BTFs have also been implicated in increasing the diversity of the gut microbiota in enterally fed children. However, concerns have been raised that BTFs may be inferior to CFs in energy and nutrition sufficiency. Issues such as microbial contamination, tube blockages, and difficulties in preparation and administration may also complicate the use of BTFs. Additionally, like CFs, BTFs can vary significantly in nutrition composition, and dietitian involvement with BTF use is crucial. The current literature on the clinical outcomes of BTF use is limited, and further research is needed before recommendations can be made on BTF use in children. A literature review was conducted to compare clinical outcomes between BTFs and CFs and evaluate the feasibility of BTF use in children.
Collapse
Affiliation(s)
- Neha Chandrasekar
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Dehlsen
- Department of Nutrition and Dietetics, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Department of Paediatric Gastroenterology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Steven T Leach
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Usha Krishnan
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Paediatric Gastroenterology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| |
Collapse
|
19
|
Mercer-Smith GW, Kirk C, Gemmell L, Mountford C, Nightingale J, Thompson N. British Intestinal Failure Alliance (BIFA) guidance - haematological and biochemical monitoring of adult patients receiving home parenteral nutrition. Frontline Gastroenterol 2021; 12:656-663. [PMID: 34925749 PMCID: PMC8640426 DOI: 10.1136/flgastro-2020-101758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/12/2021] [Accepted: 01/17/2021] [Indexed: 02/04/2023] Open
Abstract
Home parenteral nutrition (HPN) is necessary for patients with prolonged intestinal failure which can be secondary to a variety of pathophysiological mechanisms or surgical resection. HPN is needed to supply micronutrients, macronutrients and water to reduce morbidity and mortality and to maximise the patient's quality of life. HPN requires close monitoring by a dedicated multidisciplinary team and is vital to minimise complications; both catheter related and metabolic. A regular comprehensive review is required including history, examination including anthropometry and blood testing. The focus of this review is on the monitoring of haematological and biochemical parameters. There is a paucity of evidence-based literature on the biochemical monitoring of HPN and existing guidance is sourced mostly on expert opinion and lower grade studies. Sources offering guidance on the frequency of biochemical monitoring for the stable adult HPN patient are the British Association for Parenteral and Enteral Nutrition, the European Society for Parenteral and Enteral Nutrition, the National Institute for Health and Care Excellence and the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN). The aim of this work is to review and collate this existing guidance into one clear and concise review. It is recommended that biochemical parameters are checked at baseline, thereafter more frequently if concerns arise and less frequently when the patient's condition is stable, as assessed by the multidisciplinary team with expertise in HPN.
Collapse
Affiliation(s)
- Gavin William Mercer-Smith
- Blood Sciences, Newcastle upon Tyne Hospitals Department of Laboratory Medicine, Newcastle upon Tyne, UK
| | - Colette Kirk
- Nutrition - Newcastle Hospitals, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lisa Gemmell
- Nutrition - Newcastle Hospitals, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Christopher Mountford
- Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Jeremy Nightingale
- Gastroenterology, London North West University Healthcare NHS Trust, Harrow, London, UK
| | - Nick Thompson
- Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| |
Collapse
|
20
|
Rosas-Flota X, Castillo-Martínez L, Reyes-Ramírez AL, Martínez-Soto Holguín MC, Serralde-Zúñiga AE. Adaptation of the medical-nutrition therapy for patients with intestinal failure in a developing country: A modified Delphi survey. Clin Nutr ESPEN 2020; 40:187-192. [PMID: 33183535 DOI: 10.1016/j.clnesp.2020.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Intestinal Failure (IF) is a complex disease with huge impacts on our society due to complications. Therefore, in a developing country like Mexico without specialized IF clinics, health care professionals must provide evidence-based interventions for the IF patient. This study aims to achieve consensus on how to adapt the existing guidelines for IF to the local practices considering the available resources and local practices. METHODS A three-round modified Delphi process was used to build consensus on the most important interventions for our IF patients. For each round, data was collected and consensus was defined as ≥80% of agreement for each item. Descriptive statistics were used to determine whether a consensus was achieved. RESULTS Ten content experts completed the three-round modified Delphi survey. Consensus was achieved for 98% of the items related to the hospitalized patient, ambulatory care management, and drug therapy. Some of these items are not included in the ESPEN guidelines for IF, but we considered that they are relevant in our clinical practice, like the calculation of fluids for patients with very low body weight, screening for refeeding syndrome and the use of some conventional drugs to promote intestinal rehabilitation. CONCLUSIONS Using a three-round modified Delphi process, consensus was achieved for nearly all items. This represents a starting point for the improvement of our local practices towards this complex disease, leading to better outcomes and the implementation of evidence-based protocolized interventions which can have an important impact due to the lack of access to some of the most novel pharmacological therapies like the glucagon-like-peptide (GLP-2) analog.
Collapse
Affiliation(s)
- Ximena Rosas-Flota
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Universidad Nacional Autónoma de México, Facultad de Medicina, Div. Estudios de Posgrado, Mexico.
| | - Lilia Castillo-Martínez
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Ana L Reyes-Ramírez
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | - Aurora E Serralde-Zúñiga
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| |
Collapse
|
21
|
Cotogni P, Mussa B, Degiorgis C, De Francesco A, Pittiruti M. Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter-Days. JPEN J Parenter Enteral Nutr 2020; 45:768-776. [PMID: 32511768 DOI: 10.1002/jpen.1939] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/17/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Whether peripherally inserted central catheters (PICCs) are appropriate as safe and durable venous access devices (VADs) is still controversial. The aim of this 7-year, prospective cohort study was to compare the incidence rate differences of catheter-related complications (CRCs) among 4 types of central VADs in cancer patients receiving home parenteral nutrition (HPN). METHODS We enrolled all adult cancer outpatients who were candidates for HPN and who had a central VAD inserted during the study period, focusing on the incidence rate of CRCs. RESULTS We evaluated 854 central VADs (401 PICCs, 137 nontunneled centrally inserted central catheters [CICCs], 118 tunneled-cuffed CICCs, and 198 ports) in 761 patients, for a total of 169,116 catheter-days. Overall, the rate of total CRCs was 1.08/1000 catheter-days. The incidence of catheter-related bloodstream infections was low (0.29/1000), particularly for PICCs (0.08/1000; P < .001 vs tunneled-cuffed CICCs) and for ports (0.21/1000; P < .019 vs tunneled-cuffed CICCs). The rates of mechanical complications (0.58/1000) and of catheter-related symptomatic thrombosis (0.09/1000) were low and similar for PICCs, tunneled-cuffed CICCs, and ports. In terms of duration and removal rate due to complications, PICCs were like tunneled-cuffed CICCs and ports. Altogether, PICCs had fewer total complications than tunneled-cuffed CICCs (P < .001), there was no difference in total complications between PICCs and ports. CONCLUSION PICCs had significantly better outcomes than tunneled-cuffed CICCs and were safe and durable as ports. Our extensive, long-term study suggests that PICCs can be successfully used as safe and long-lasting VADs for HPN in cancer patients.
Collapse
Affiliation(s)
- Paolo Cotogni
- Unit of Parenteral Nutrition in Oncology, Department of Internal Medicine, Molinette Hospital, Turin, Italy
| | - Baudolino Mussa
- Central Venous, Access Team, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Claudia Degiorgis
- Central Venous, Access Team, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | | | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy
| |
Collapse
|
22
|
Grillot J, Ait S, Bergoin C, Couronne T, Blond E, Peraldi C, Barnoud D, Chambrier C, Lauverjat M. Vitamin C in Home Parenteral Nutrition: A Need for Monitoring. Nutrients 2020; 12:nu12061667. [PMID: 32503297 PMCID: PMC7352530 DOI: 10.3390/nu12061667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022] Open
Abstract
To date, there are no recommendations about screening plasma vitamin C concentration and adjust its supplementation in patients on long-term home parenteral nutrition (HPN). The aim of this study was to evaluate vitamin C status and determine if a commercial multivitamin preparation (CMVP) containing 125 mg of vitamin C is sufficient in stable patients on HPN. All clinically stable patients receiving HPN or an intravenous fluid infusion at least two times per week for at least 6 months, hospitalized for nutritional assessment, were retrospectively included, for a total of 186 patients. We found that 29% of the patients had vitamin C insufficiency (i.e., <25 µmol/L). In univariate analysis, C-reactive protein (CRP) (p = 0.002) and intake of only 125 mg of vitamin C (p = 0.001) were negatively associated with vitamin C levels, and duration of follow-up in our referral center (p = 0.009) was positively associated with vitamin C levels. In multivariate analysis, only CRP (p = 0.001) and intake of 125 mg of vitamin C (p < 0.0001) were independently associated with low plasma vitamin C concentration. Patients receiving only CMVP with a low plasma vitamin C level significantly received personal compounded HPN (p = 0.008) and presented an inflammatory syndrome (p = 0.002). Vitamin C insufficiency is frequent in individuals undergoing home parenteral nutrition; therefore, there is a need to monitor plasma vitamin C levels, especially in patients on HPN with an inflammatory syndrome and only on CMVP.
Collapse
Affiliation(s)
- Julienne Grillot
- Nutrition Intensive Care Unit, Hospices Civil de Lyon, CEDEX, F-69495 Pierre Benite, France; (S.A.); (C.B.); (D.B.); (C.C.)
- CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, CEDEX, 69921 Oullins, France;
- Correspondence: ; Tel.: +33-478-86-39-91
| | - Sabrina Ait
- Nutrition Intensive Care Unit, Hospices Civil de Lyon, CEDEX, F-69495 Pierre Benite, France; (S.A.); (C.B.); (D.B.); (C.C.)
| | - Charlotte Bergoin
- Nutrition Intensive Care Unit, Hospices Civil de Lyon, CEDEX, F-69495 Pierre Benite, France; (S.A.); (C.B.); (D.B.); (C.C.)
| | - Thomas Couronne
- Department of Gastroenterology, Hospices Civils de Lyon, CEDEX, F-69495 Pierre Benite, France;
| | - Emilie Blond
- CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, CEDEX, 69921 Oullins, France;
- Biochemistry Department, Lyon Sud Hospital, Hospices Civils de Lyon, F-69495 Pierre Benite, France
| | - Catherine Peraldi
- Centre Agréé de Nutrition Parentérale à Domicile, Hospices Civils de Lyon, CEDEX, F-69495 Pierre Benite, France; (C.P.); (M.L.)
| | - Didier Barnoud
- Nutrition Intensive Care Unit, Hospices Civil de Lyon, CEDEX, F-69495 Pierre Benite, France; (S.A.); (C.B.); (D.B.); (C.C.)
| | - Cécile Chambrier
- Nutrition Intensive Care Unit, Hospices Civil de Lyon, CEDEX, F-69495 Pierre Benite, France; (S.A.); (C.B.); (D.B.); (C.C.)
- Centre Agréé de Nutrition Parentérale à Domicile, Hospices Civils de Lyon, CEDEX, F-69495 Pierre Benite, France; (C.P.); (M.L.)
| | - Madeleine Lauverjat
- Centre Agréé de Nutrition Parentérale à Domicile, Hospices Civils de Lyon, CEDEX, F-69495 Pierre Benite, France; (C.P.); (M.L.)
| |
Collapse
|
23
|
Pironi L, Boeykens K, Bozzetti F, Joly F, Klek S, Lal S, Lichota M, Mühlebach S, Van Gossum A, Wanten G, Wheatley C, Bischoff SC. ESPEN guideline on home parenteral nutrition. Clin Nutr 2020; 39:1645-1666. [PMID: 32359933 DOI: 10.1016/j.clnu.2020.03.005] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 02/07/2023]
Abstract
This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion line and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN.
Collapse
Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, St. Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Kurt Boeykens
- AZ Nikolaas Hospital, Nutrition Support Team, Sint-Niklaas, Belgium
| | | | - Francisca Joly
- Beaujon Hospital, APHP, Clichy, University of Paris VII, France
| | | | - Simon Lal
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Stefan Mühlebach
- Division of Clinical Pharmacy and Epidemiology and Hospital Pharmacy, University of Basel, Basel, Switzerland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), United Kingdom
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| |
Collapse
|
24
|
Osland EJ, McGrath KH, Ali A, Carey S, Daniells S, Angstmann K, Bines J, Asrani V, Watson C, Jones L, De Cruz P. A framework to support quality of care for patients with chronic intestinal failure requiring home parenteral nutrition. J Gastroenterol Hepatol 2020; 35:567-576. [PMID: 31441085 DOI: 10.1111/jgh.14841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/18/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Chronic intestinal failure requiring home parenteral nutrition (HPN) is a disabling condition that is best facilitated by a multidisciplinary approach to care. Variation in care has been identified as a key barrier to achieving quality of care for patients on HPN and requires appropriate strategies to help standardize management. METHOD The Australasian Society for Parenteral and Enteral Nutrition (AuSPEN) assembled a multidisciplinary working group of 15 clinicians to develop a quality framework to assist with the standardization of HPN care in Australia. Obstacles to quality care specific to Australia were identified by consensus. Drafts of the framework documents were based on the available literature and refined by two Delphi rounds with the clinician work group, followed by a further two involving HPN consumers. The Oxford Centre for Evidence-Based Medicine Levels of Evidence was used to assess the strength of evidence underpinning each concept within the framework documents. RESULTS Quality indicators, standards of care, and position statements have been developed to progress the delivery of quality care to HPN patients. CONCLUSION The quality framework proposed by AuSPEN is intended to provide a practical structure for clinical and organizational aspects of HPN service delivery to reduce variation in care and improve quality of care and represents the initial step towards development of a national model of care for HPN patients in Australia. While developed for implementation in Australia, the evidence-based framework also has relevance to the international HPN community.
Collapse
Affiliation(s)
- Emma J Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Human Movements and Nutrition Science, University of Queensland, Brisbane, Queensland, Australia
| | - Kathleen H McGrath
- Department of Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK.,Intestinal Failure and Clinical Nutrition Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Azmat Ali
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Sharon Carey
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Suzie Daniells
- Department of Nutrition and Dietetics, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Katerina Angstmann
- Division Surgery, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - Julie Bines
- Intestinal Failure and Clinical Nutrition Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Varsha Asrani
- Department of Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand.,Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Caitlin Watson
- Department of Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Lynn Jones
- Intestinal Failure Service, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, Austin Academic Centre, University of Melbourne, Heidelberg, Victoria, Australia
| |
Collapse
|
25
|
Vlug LE, Nagelkerke SCJ, Jonkers-Schuitema CF, Rings EHHM, Tabbers MM. The Role of a Nutrition Support Team in the Management of Intestinal Failure Patients. Nutrients 2020; 12:nu12010172. [PMID: 31936271 PMCID: PMC7019598 DOI: 10.3390/nu12010172] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/02/2020] [Accepted: 01/04/2020] [Indexed: 12/15/2022] Open
Abstract
Parenteral nutrition (PN) is a complex and specialized form of nutrition support that has revolutionized the care for both pediatric and adult patients with acute and chronic intestinal failure (IF). This has led to the development of multidisciplinary teams focused on the management of patients receiving PN: nutrition support teams (NSTs). In this review we aim to discuss the historical aspects of IF management and NST development, and the practice, composition, and effectiveness of multidisciplinary care by NSTs in patients with IF. We also discuss the experience of two IF centers as an example of contemporary NSTs at work. An NST usually consists of at least a physician, nurse, dietitian, and pharmacist. Multidisciplinary care by an NST leads to fewer complications including infection and electrolyte disturbances, and better survival for patients receiving short- and long-term PN. Furthermore, it leads to a decrease in inappropriate prescriptions of short-term PN leading to significant cost reduction. Complex care for patients receiving PN necessitates close collaboration between team members and NSTs from other centers to optimize safety and effectiveness of PN use.
Collapse
Affiliation(s)
- Lotte E. Vlug
- Erasmus Medical Center, Department of Pediatric Gastroenterology, Erasmus University Rotterdam, Sophia Children’s Hospital, 3015 GD Rotterdam, The Netherlands
- Correspondence: (L.E.V.); (S.C.J.N.)
| | - Sjoerd C. J. Nagelkerke
- Amsterdam UMC, Department of Pediatric Gastroenterology, University of Amsterdam, Emma Children’s Hospital, Hepatology and Nutrition, 1105 AZ Amsterdam, The Netherlands
- Correspondence: (L.E.V.); (S.C.J.N.)
| | - Cora F. Jonkers-Schuitema
- Amsterdam UMC, Department of Pediatric Gastroenterology, University of Amsterdam, Emma Children’s Hospital, Hepatology and Nutrition, 1105 AZ Amsterdam, The Netherlands
| | - Edmond H. H. M. Rings
- Erasmus Medical Center, Department of Pediatric Gastroenterology, Erasmus University Rotterdam, Sophia Children’s Hospital, 3015 GD Rotterdam, The Netherlands
- Department of Pediatric Gastroenterology, Leiden University Medical Center, University of Leiden, Willem Alexander Children’s Hospital, 2300 RC Leiden, The Netherlands
| | - Merit M. Tabbers
- Amsterdam UMC, Department of Pediatric Gastroenterology, University of Amsterdam, Emma Children’s Hospital, Hepatology and Nutrition, 1105 AZ Amsterdam, The Netherlands
| |
Collapse
|
26
|
Abstract
The ability to provide parenteral support represents a revolutionary change in medical therapy for patients with temporary and inadequate intestinal absorptive capacity or for patients with chronic intestinal failure due to digestive diseases. Nevertheless, due to the rarity of intestinal failure, a de facto policy of "discrimination by organ failure treatment" exists in many countries whereby this problem is under-recognized and under-treated. With the increasing recognition of the pathophysiological consequences of intestinal resection and the occurrence of new pro-adaptive treatments for patients suffering from short bowel syndrome, this review reflects on the history of developments in this area and discusses current practice and future directions of the field.
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW This review discusses the monitoring aimed at achieving good long-term outcomes in people dependent on home parenteral nutrition (HPN). RECENT FINDINGS There have been recent studies highlighting the importance of treating low bone mineral density in HPN-dependent patients, methods of screening for liver disease, assessment of quality of life (QoL) and the need for early assessment for intestinal transplantation and growth factor therapy. SUMMARY High-quality HPN services require expert multidisciplinary teams with a focus on strict aseptic catheter care protocols alongside regular monitoring and management of clinical, laboratory and patient-related factors. Areas that should be considered in the routine monitoring of HPN include regular laboratory measurements, QoL, assessment for intestinal failure-associated liver disease, treatment of metabolic bone disease and consideration of evolving treatments, alongside management of any underlying condition leading to intestinal failure.
Collapse
Affiliation(s)
- Martyn Dibb
- Royal Liverpool University Hospital, Liverpool
| | - Simon Lal
- Salford Royal Hospital, Salford, England, UK
| |
Collapse
|
28
|
Carey S, Tu W, Hyde‐Jones L, Koh C. Assessing Patient Preferences for Intestinal Failure Management Using the Time Trade‐Off Methodology. JPEN J Parenter Enteral Nutr 2019; 43:912-917. [DOI: 10.1002/jpen.1506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/03/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Sharon Carey
- Royal Prince Alfred Hospital Sydney Australia
- University of Sydney Sydney Australia
| | - Wendy Tu
- University of Sydney Sydney Australia
| | | | - Cherry Koh
- Royal Prince Alfred Hospital Sydney Australia
- University of Sydney Sydney Australia
| |
Collapse
|
29
|
Hon K, Bihari S, Holt A, Bersten A, Kulkarni H. Rate of Catheter-Related Bloodstream Infections Between Tunneled Central Venous Catheters Versus Peripherally Inserted Central Catheters in Adult Home Parenteral Nutrition: A Meta-analysis. JPEN J Parenter Enteral Nutr 2018; 43:41-53. [PMID: 30035806 DOI: 10.1002/jpen.1421] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Tunneled central venous catheters (TCVCs) and peripherally inserted central catheters (PICC) are often used for the provision of home parenteral nutrition (HPN). There is no formal comparison being made to study the rate of catheter-related bloodstream infection (CRBSI) between TCVCs and PICC in HPN to recommend the use of 1 over the other. METHODS An online MEDLINE, PubMed, and Scopus search was conducted. Studies reporting the rate of CRBSI in HPN patients were included. DerSimonian and Laird random effects meta-analyses were used to analyze comparative studies, whereas Begg and Pilote's random effects meta-analysis was used to pool and analyze single-arm studies. RESULTS Seventeen studies (12 single-arm studies and 5 comparative studies) were included for analysis. Meta-analysis of comparative studies showed that PICC use was associated with a significantly lower rate of CRBSI (relative risk (RR) 0.40, 95% CI 0.19-0.83), whereas meta-analysis of single-arm studies revealed that the relative risk for CRBSI was not statistically significantly different from unity. CONCLUSION TCVC is more commonly used in long-term HPN. Our analysis of comparative studies showed a lower rate of CRBSI in HPN patients using PICC compared with TCVC; however, analysis of single-arm studies showed that the rate of CRBSI was comparable in PICC and TCVC use. The decision to which type of catheter is most suited for HPN patients should hence be based on the duration of treatment, level of care, patients' dexterity, as well patients' underlying comorbidities that may potentially contribute to other catheter-related complications.
Collapse
Affiliation(s)
- Kay Hon
- College of Medicine, Flinders University, South Australia, Australia
| | - Shailesh Bihari
- College of Medicine, Flinders University, South Australia, Australia.,Department of Intensive and Critical Care Unit, Flinders Medical Centre, South Australia, Australia
| | - Andrew Holt
- College of Medicine, Flinders University, South Australia, Australia.,Department of Intensive and Critical Care Unit, Flinders Medical Centre, South Australia, Australia.,South Australia Home Parenteral Nutrition Unit, Flinders Medical Centre, South Australia, Australia
| | - Andrew Bersten
- College of Medicine, Flinders University, South Australia, Australia.,Department of Intensive and Critical Care Unit, Flinders Medical Centre, South Australia, Australia
| | | |
Collapse
|
30
|
Carey S, Kalachov M, Jones L, Koh C. Development of consensus on models of care in adults with intestinal failure using a modified Delphi approach. J Gastroenterol Hepatol 2018; 33:1598-1602. [PMID: 29485752 DOI: 10.1111/jgh.14132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The aims of this study were to establish consensus on service delivery models for management of Type III intestinal failure (IF) and home parenteral nutrition (HPN) within the Australian health-care system and to identify barriers and enablers in moving towards this ideal model. METHODS A modified Delphi methodology was utilized to survey experts working in Type III IF HPN. The panel comprised physicians, dietitians, nurses, and pharmacists from 18 of the 20 adult Type III IF HPN centres across Australia. The study consisted of two rounds of email administered questionnaires developed around four key areas of health service delivery: access to services, clinical care, service guidance, and models of care. Open-ended responses were evaluated via an inductive thematic approach to identify areas of consensus. Experts reviewed the final report to consolidate consensus and validity. RESULTS There was >80% consensus that an ideal team should consist of a physician, nurse, dietitian, pharmacist, and access to psychological support. Consensus supported the need for updated guidelines (75%) and a hub and spoke model of care (82%). However, further consultation is required in order to establish consensus around the use of HPN in the palliative oncology setting (69%). CONCLUSIONS This consensus provides a framework within which health professionals, managers, policy-makers, and consumer groups can move towards optimal management for Type III IF HPN patients. Advocacy and a review of service delivery across Australia are now required to facilitate the ideal model of care identified.
Collapse
Affiliation(s)
- Sharon Carey
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, Australia
- Nutrition and Dietetics Group, University of Sydney, Sydney, Australia
| | - Michelle Kalachov
- Nutrition and Dietetics Group, University of Sydney, Sydney, Australia
| | - Lynn Jones
- Department of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Cherry Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Surgical Outcomes Research Unit, Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| |
Collapse
|
31
|
Smith A, Feuling MB, Larson-Nath C, Karls C, Van Hoorn M, Walia CLS, Leon C, Danner E, Opichka P, Duesing L, Martinez A, Goday PS. Laboratory Monitoring of Children on Home Parenteral Nutrition: A Prospective Study. JPEN J Parenter Enteral Nutr 2018; 42:148-155. [PMID: 29505155 DOI: 10.1177/0148607116673184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/13/2016] [Indexed: 10/13/2023]
Abstract
BACKGROUND The primary hypothesis of this article is that a team approach in creating a protocolized laboratory monitoring schedule for home parenteral nutrition (PN) patients improves patient safety by decreasing the occurrence of nutrition deficiencies and is cost-effective. METHODS In this prospective cohort study of home PN patients, each patient followed an established protocol of laboratory monitoring and weekly review by an interdisciplinary team of dietitians, nurses, and physicians. Data collected included anthropometric measurements, laboratory results, deviations from laboratory protocols, laboratory charges, PN shortage information, and means of ameliorating such shortages. Cost-effectiveness analysis was only performed for nonmicronutrient laboratory tests. RESULTS Fifteen children (male, n = 6) with a median age of 59 months (range, 19-216) were included in this study. Primary diagnoses included short bowel syndrome (47%) and intestinal pseudo-obstruction (40%). Patients received PN mixtures from 6 different infusion companies and experienced 60 different shortages in the PN formulation requiring adjustments or substitutions (mean, 4 shortages per patient). All patients had appropriate growth and complete micronutrient monitoring. No patient experienced any clinical symptoms due to shortages. The median number of laboratory draws/patient per month was 2.9 preprotocol compared with 1.14 postprotocol (P = .003). The median per patient per month charges were $2014 (interquartile range [IQR], 1471-2780) preprotocol compared with $792 (IQR, 435-1140) postprotocol (P = .002). CONCLUSIONS A structured team approach to laboratory monitoring of home PN patients can simplify PN management, significantly decrease monthly laboratory costs, and lead to fewer laboratory draws while improving micronutrient monitoring and preventing deficiencies.
Collapse
Affiliation(s)
- Amber Smith
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | | | | | | | - Carly Leon
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elaine Danner
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pam Opichka
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lori Duesing
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | |
Collapse
|
32
|
Lauverjat M, Ait S, Barnoud D, Bergoin C, Peraldi C, Chambrier C. Surveillance de la nutrition parentérale de courte et de longue durée. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2017.06.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
33
|
Anticoagulants for the prevention and treatment of catheter-related thrombosis in adults and children on parenteral nutrition: a systematic review and critical appraisal. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 15:369-377. [PMID: 27483479 DOI: 10.2450/2016.0031-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/11/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients on parenteral nutrition require a central venous access and are at risk of catheter-related thrombosis, pulmonary embolism, and vena cava syndrome. Parenteral nutrition guidelines suggest anticoagulation for the primary prevention of catheter-related thrombosis during long-term parenteral nutrition. We conducted a systematic review of the efficacy, safety and feasibility of anticoagulant use for preventing and treating catheter-related thrombosis during parenteral nutrition. MATERIALS AND METHODS We searched for interventional and observational studies on adults and children receiving systemic anticoagulants during either short- or long-term parenteral nutrition delivered via central venous access. Primary outcomes were: objectively-confirmed catheter-related thrombosis, pulmonary embolism and bleeding. Secondary outcomes were: heparin-induced thrombocytopenia, prevalence of anticoagulation, and quality of International Normalised Ratio management in vitamin K antagonist-treated patients. RESULTS We identified 1,199 studies, of which 23 were included. Seven interventional studies of short-term parenteral nutrition (adult population, n=5) were classified as low-quality: in those, intravenous unfractionated heparin did not prevent catheter-related thrombosis if compared to saline. No interventional studies were conducted in patients on long-term parenteral nutrition. Observational data were sparse, rarely focusing on anticoagulation, and overall of low quality. The reported use of anticoagulants was between 22 and 66% in recent multicentre cohorts. DISCUSSION The amount and quality of data in this area are very suboptimal: most studies are outdated and involved heterogeneous populations. Currently, there is insufficient evidence to allow conclusions to be reached regarding the efficacy and safety of anticoagulants in this setting.
Collapse
|
34
|
Barco S, Heuschen CBBCM, Salman B, Brekelmans MPA, Serlie MJ, Middeldorp S, Coppens M. Home parenteral nutrition-associated thromboembolic and bleeding events: results of a cohort study of 236 individuals. J Thromb Haemost 2016; 14:1364-73. [PMID: 27122107 DOI: 10.1111/jth.13351] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/22/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED Essentials Sparse or outdated studies focus on thrombotic and bleeding risk in home parenteral nutrition (HPN). 236 HPN patients followed at a single center for a total of 684 patient-years were evaluated. Rates of venous thrombosis and major bleeding, and prevalence of vena cava syndrome are provided. Anticoagulants might reduce thrombosis risk, but population-specific safety concerns remain. SUMMARY Background Home parenteral nutrition (HPN) is necessary for patients with intestinal failure. Recurrent catheter-related thrombosis (CRT) is common, leading to infectious complications, pulmonary embolism, vascular access loss and intestinal transplantation. The efficacy and safety of anticoagulants are unknown in this setting and based on sparse and low-quality observational data. Objectives Our aim was to estimate the incidence of thromboembolic, bleeding and anticoagulant-related complications in HPN patients, and evaluate risk factors for first venous thrombosis (VT). Methods This retrospective cohort study included all adult patients followed for long-term HPN at our center between 1986 and 2014. Primary outcomes were symptomatic objectively diagnosed VT, encompassing CRT and venous thromboembolism, and major bleeding. Secondary outcomes were vena cava syndrome and heparin-induced thrombocytopenia or hypersensitivity. Results A total of 236 patients were included (median HPN duration, 17 months) and 136 received anticoagulants at HPN onset (57.6%). Overall, the annual incidence of first VT was 11.4% (95% confidence interval [95% CI], 8.6-14.7%); VT was associated with a personal history of thrombosis (adjusted hazard ratio, 2.22; 95% CI, 1.06-4.64), whereas anticoagulation seemed to account only for a mild protection (adjusted hazard ratio, 0.72; 95% CI, 0.36-1.44). The annual incidence of major bleeding was 4.3% for patients on anticoagulants vs. 1.8% for those off anticoagulants. Vena cava syndrome developed in 20.7% of patients with VT. One patient had isolated heparin-induced thrombocytopenia (0.6%) and four had heparin hypersensitivity (2.5%). Conclusions Patients on HPN have a significant risk of venous thrombosis, major bleeding and vena cava syndrome. Anticoagulants might reduce thrombosis risk, but population-specific safety concerns remain.
Collapse
Affiliation(s)
- S Barco
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, University Medical Center Mainz, Mainz, Germany
| | - C B B C M Heuschen
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - B Salman
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - M P A Brekelmans
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - M J Serlie
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - S Middeldorp
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - M Coppens
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
35
|
Pironi L, Arends J, Bozzetti F, Cuerda C, Gillanders L, Jeppesen PB, Joly F, Kelly D, Lal S, Staun M, Szczepanek K, Van Gossum A, Wanten G, Schneider SM. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016; 35:247-307. [PMID: 26944585 DOI: 10.1016/j.clnu.2016.01.020] [Citation(s) in RCA: 457] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Chronic Intestinal Failure (CIF) is the long-lasting reduction of gut function, below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. CIF is the rarest organ failure. Home parenteral nutrition (HPN) is the primary treatment for CIF. No guidelines (GLs) have been developed that address the global management of CIF. These GLs have been devised to generate comprehensive recommendations for safe and effective management of adult patients with CIF. METHODS The GLs were developed by the Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds, and accepted in an online survey of ESPEN members. RESULTS The following topics were addressed: management of HPN; parenteral nutrition formulation; intestinal rehabilitation, medical therapies, and non-transplant surgery, for short bowel syndrome, chronic intestinal pseudo-obstruction, and radiation enteritis; intestinal transplantation; prevention/treatment of CVC-related infection, CVC-related occlusion/thrombosis; intestinal failure-associated liver disease, gallbladder sludge and stones, renal failure and metabolic bone disease. Literature search provided 623 full papers. Only 12% were controlled studies or meta-analyses. A total of 112 recommendations are given: grade of evidence, very low for 51%, low for 39%, moderate for 8%, and high for 2%; strength of recommendation: strong for 63%, weak for 37%. CONCLUSIONS CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for both the underlying gastrointestinal disease and to provide HPN support. The rarity of the condition impairs the development of RCTs. As a consequence, most of the recommendations have a low or very low grade of evidence. However, two-thirds of the recommendations are considered strong. Specialized management and organization underpin these recommendations.
Collapse
Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | | | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Lyn Gillanders
- Nutrition Support Team, Auckland City Hospital, (AuSPEN) Auckland, New Zealand
| | | | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Darlene Kelly
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA; Oley Foundation for Home Parenteral and Enteral Nutrition, Albany, NY, USA
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - Michael Staun
- Rigshospitalet, Department of Gastroenterology, Copenhagen, Denmark
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - André Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Stéphane Michel Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France
| | | |
Collapse
|
36
|
Predicted versus measured resting energy expenditure in patients requiring home parenteral nutrition. Nutrition 2015; 31:1328-32. [DOI: 10.1016/j.nut.2015.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 11/19/2022]
|
37
|
Hortencio TDR, Arendt BM, Teterina A, Jeejeebhoy KN, Gramlich LM, Whittaker JS, Armstrong D, Raman M, Nogueira RJN, Allard JP. Changes in Home Parenteral Nutrition Practice Based on the Canadian Home Parenteral Nutrition Patient Registry. JPEN J Parenter Enteral Nutr 2015; 41:830-836. [DOI: 10.1177/0148607115609289] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Taís Daiene Russo Hortencio
- State University of Campinas, Unicamp, São Paulo, Brazil
- Toronto General Hospital, University Health Network, Toronto, Canada
| | | | | | | | | | - J. Scott Whittaker
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, Canada
| | - David Armstrong
- Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | | | | | - Johane P. Allard
- Toronto General Hospital, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
38
|
Edakkanambeth Varayil J, Yadav S, Miles JM, Okano A, Kelly DG, Hurt RT, Mundi MS. Hyperglycemia During Home Parenteral Nutrition Administration in Patients Without Diabetes. JPEN J Parenter Enteral Nutr 2015; 41:672-677. [DOI: 10.1177/0148607115606116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Jithinraj Edakkanambeth Varayil
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Second Department of Internal Medicine, Charles University Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Siddhant Yadav
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - John M. Miles
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Akiko Okano
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Darlene G. Kelly
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Ryan T. Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
39
|
Emery D, Pearson A, Lopez R, Hamilton C, Albert NM. Voiceover Interactive PowerPoint Catheter Care Education for Home Parenteral Nutrition. Nutr Clin Pract 2015; 30:714-9. [DOI: 10.1177/0884533615584391] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Dorothy Emery
- Center for Human Nutrition, Digestive Disease Institute
| | | | | | | | - Nancy M. Albert
- Nursing Institute, Office of Research and Innovation, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
40
|
ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr 2014; 34:171-80. [PMID: 25311444 DOI: 10.1016/j.clnu.2014.08.017] [Citation(s) in RCA: 361] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/20/2014] [Accepted: 08/23/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Intestinal failure (IF) is not included in the list of PubMed Mesh terms, as failure is the term describing a state of non functioning of other organs, and as such is not well recognized. No scientific society has yet devised a formal definition and classification of IF. The European Society for Clinical Nutrition and Metabolism guideline committee endorsed its "home artificial nutrition and chronic IF" and "acute IF" special interest groups to write recommendations on these issues. METHODS After a Medline Search, in December 2013, for "intestinal failure" and "review"[Publication Type], the project was developed using the Delphi round methodology. The final consensus was reached on March 2014, after 5 Delphi rounds and two live meetings. RESULTS The recommendations comprise the definition of IF, a functional and a pathophysiological classification for both acute and chronic IF and a clinical classification of chronic IF. IF was defined as "the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth". CONCLUSIONS This formal definition and classification of IF, will facilitate communication and cooperation among professionals in clinical practice, organization and management, and research.
Collapse
|
41
|
Flushing the central venous catheter: is heparin necessary? J Vasc Access 2014; 15:241-8. [PMID: 24811598 DOI: 10.5301/jva.5000225] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this systematic review was to assess the efficacy of heparin flushing in the lock of central venous catheters. METHODS We searched MEDLINE and CINAHL databases. Eligible studies were randomized controlled trials evaluating the use of heparin versus normal saline or other solution in the flushing of central catheter among adult patients. No language restrictions were applied. Two reviewers independently screened titles and abstracts in order to identify relevant publications. The same two reviewers retrieved and evaluated full texts. Parameter estimates regarding catheter occlusion were pooled using network meta-analysis with Bayesian hierarchical modeling. RESULTS We identified 462 references. Eight studies were included. There was no evidence that heparin was more effective than normal saline in reducing occlusions. It was unclear whether urokinase and lepirudin were more effective than heparin in reducing occlusions. Vitamin C solution does not appear to prolong catheter patency. CONCLUSIONS There is no evidence of a different effectiveness between heparin flushing and normal saline or other solutions in reducing catheter occlusions. Due to the little and inconclusive evidence available in this field, further studies might be necessary.
Collapse
|
42
|
Schliefert E, Carey S. Nutritional status and quality of life in a cohort of Australian home parenteral nutrition patients: A pilot study. Nutr Diet 2013. [DOI: 10.1111/1747-0080.12078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Emma Schliefert
- Clinical Nutrition Unit; University of Sydney; Sydney New South Wales Australia
| | - Sharon Carey
- Clinical Nutrition Unit; University of Sydney; Sydney New South Wales Australia
- Department of Nutrition and Dietetics; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| |
Collapse
|
43
|
Wall EA. An overview of short bowel syndrome management: adherence, adaptation, and practical recommendations. J Acad Nutr Diet 2013; 113:1200-8. [PMID: 23830324 DOI: 10.1016/j.jand.2013.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 04/30/2013] [Indexed: 12/14/2022]
Abstract
Short bowel syndrome (SBS) refers to the clinical consequences resulting from loss of small bowel absorptive surface area due to surgical resection or bypass. The syndrome is characterized by maldigestion, malabsorption, and malnutrition. Survival of patients with SBS is dependent on adaptation in the remaining bowel and a combination of pharmacologic and nutrition therapies. Individual plans of care are developed based on the length and sites of remaining bowel, the degree of intestinal adaptation, and the patient's ability to adhere to the medication and dietary regimens. Antisecretory and antidiarrheal medications are prescribed to slow intestinal transit times and optimize fluid and nutrient absorption. Based on postsurgical anatomy, enteral feedings, parenteral infusions, complex diet plans, and vitamin and mineral supplementation are used in various combinations to nourish patients with SBS. In the acute care setting, registered dietitians (RDs) assist with infusion therapy, diet education, and discharge planning. Long-term, as the small intestine adapts, RDs revise the nutrition care plan and monitor for nutrient deficiencies, metabolic bone disease, and anemia. The frequent monitoring and revision of care plans, plus the appreciable benefits from proper medical nutrition therapy, make this patient population extremely challenging and rewarding for RDs to manage. This article provides a brief, case study-based overview of the medical and nutrition management of SBS.
Collapse
|
44
|
Dreesen M, Foulon V, Vanhaecht K, Hiele M, De Pourcq L, Pironi L, Van Gossum A, Wanten G, Baxter JP, Joly F, Cuerda C, Willems L. Development of quality of care interventions for adult patients on home parenteral nutrition (HPN) with a benign underlying disease using a two-round Delphi approach. Clin Nutr 2013; 32:59-64. [DOI: 10.1016/j.clnu.2012.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 02/04/2023]
|
45
|
Dreesen M, Foulon V, Hiele M, Vanhaecht K, De Pourcq L, Pironi L, Van Gossum A, Arends J, Cuerda C, Thul P, Bozzetti F, Willems L. Quality of care for cancer patients on home parenteral nutrition: development of key interventions and outcome indicators using a two-round Delphi approach. Support Care Cancer 2012; 21:1373-81. [DOI: 10.1007/s00520-012-1679-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 11/27/2012] [Indexed: 11/29/2022]
|
46
|
Baxter JP, Gillanders L, Angstmann K, Staun M, O’Hanlon C, Smith T, Joly F, Thul P, Jonkers C, Wanten G, Gardiner K, Klek S, Cuerda C, Magambo W, Hawthorne AB, Lukes A, Van Gossum A, Theilla M, Singer P, Shamir R, Pironi L. Home parenteral nutrition: An international benchmarking exercise. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.clnme.2012.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
47
|
Guidelines recommendations on care of adult patients receiving home parenteral nutrition: A systematic review of global practices. Clin Nutr 2012; 31:602-8. [DOI: 10.1016/j.clnu.2012.02.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 02/17/2012] [Accepted: 02/23/2012] [Indexed: 02/07/2023]
|
48
|
Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: a systematic review. Clin Nutr 2012; 32:16-26. [PMID: 22959630 DOI: 10.1016/j.clnu.2012.08.004] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/09/2012] [Accepted: 08/13/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Catheter-related infection (CRI) is the most common and serious complication for adult patients receiving home parenteral nutrition (HPN). Our aim is to provide epidemiological data on infection incidence, infecting pathogens and contributing risk factors. METHODS Four electronic databases (Embase, Medline, IPA, CINAHL) were screened for eligible studies published between 1970 and March 2012. Methodological quality was evaluated and terminology/definitions were re-categorized. RESULTS Thirty-nine studies were included. Extensive variability was observed in terminology/definitions as well as in expression of CRI rate. After correct interpretation of definitions, overall catheter-related bloodstream infection rate (CRBSI) ranged between 0.38 and 4.58 episodes/1000 catheter days (median 1.31). Gram-positive bacteria of human skin flora caused more than half of infections. An analysis of the reported risk factors showed that the origin of a CRBSI is often multifactorial. The risk factors were related to the patient, the venous access device, the education, HPN therapy and follow-up. CONCLUSIONS This review on CRI in adult HPN patients revealed that included studies are of low quality and used poorly described risk factors and different definitions. The human skin flora caused most of infections; therefore, hand hygiene and training remain essential.
Collapse
|
49
|
Botella-Carretero JI, Carrero C, Guerra E, Valbuena B, Arrieta F, Calañas A, Zamarrón I, Balsa JA, Vázquez C. Role of Peripherally Inserted Central Catheters in Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2012; 37:544-9. [DOI: 10.1177/0148607112457422] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jose I. Botella-Carretero
- Unit of Clinical Nutrition and Obesity, Department of Endocrinology and Nutrition, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Madrid, Spain
| | - Carmen Carrero
- Unit of Clinical Nutrition and Obesity, Department of Endocrinology and Nutrition, Madrid, Spain
| | - Eva Guerra
- Department of Oncology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal para la Investigación Sanitaria (IRyCIS), Madrid, Spain
| | - Beatriz Valbuena
- Unit of Clinical Nutrition and Obesity, Department of Endocrinology and Nutrition, Madrid, Spain
| | - Francisco Arrieta
- Unit of Clinical Nutrition and Obesity, Department of Endocrinology and Nutrition, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Madrid, Spain
| | - Alfonso Calañas
- Unit of Clinical Nutrition and Obesity, Department of Endocrinology and Nutrition, Madrid, Spain
| | - Isabel Zamarrón
- Unit of Clinical Nutrition and Obesity, Department of Endocrinology and Nutrition, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Madrid, Spain
| | - Jose A. Balsa
- Unit of Clinical Nutrition and Obesity, Department of Endocrinology and Nutrition, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Infanta Sofía, Madrid, Spain
| | - Clotilde Vázquez
- Unit of Clinical Nutrition and Obesity, Department of Endocrinology and Nutrition, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Madrid, Spain
| |
Collapse
|
50
|
Central Venous Catheter-Induced Cardiac Tamponade: A Preventable Complication. J Vasc Access 2012; 13:530; author reply 530-3. [DOI: 10.5301/jva.5000078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2012] [Indexed: 11/20/2022] Open
|