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Scharek-Tedin L, Zentek J. A porcine animal model to mimic the restart of enteral nutrition (refeeding-model). Arch Anim Nutr 2019; 73:52-66. [PMID: 31274344 DOI: 10.1080/1745039x.2018.1557919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
With the aim towards establishing an animal model of total parenteral nutrition (TPN), 12 piglets aged 9 weeks (mean body weight 21 kg) were surgically provided with central venous catheters. Six piglets were nourished parenterally with the objective to reach a 14-d period of TPN; the other six piglets served as control and were fed normally. Only one animal from each group could be monitored over the whole period. Nine piglets were euthanised on d 13 and one on d 12. No animal showed fever or signs of septicaemia during the study. The levels of Ca, Mg, Na and P in the blood were within the normal range as were those for blood glucose and plasma creatinine. Symptoms of the TPN included: transient diarrhoea, occasional appearance of faecal blood and occasional absence of defecation. A reduced small intestine length and altered mucosal morphology and function were observed. One animal showed bile stasis at the end of the study. All TPN animals showed a remarkably high level of blood urea early in the morning. The intestinal symptoms observed may resemble the human situation during TPN. However, due to the fast growth rate, pigs aged 9 weeks have higher nutrient requirements per kg body weight. Consequently, the osmolality of the nutrient solution was necessarily high. Whether the significantly higher blood urea observed in the TPN group reflected a catabolic metabolism during the starving period at night-time could not be conclusively shown. Alternatively, it could reflect a slower growth rate and a resulting quantitative excess of amino acids (AA), or could have been the consequence of a suboptimal AA composition. A permanent infusion would be favourable in order not to overcharge the capacity for glucose uptake and amino acid metabolism during the infusion.
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Affiliation(s)
- Lydia Scharek-Tedin
- a Institute of Immunology, Department of Veterinary Medicine, Freie Universität Berlin , Berlin , Germany
| | - Jürgen Zentek
- b Institute of Animal Nutrition, Department of Veterinary Medicine, Freie Universität Berlin , Berlin , Germany
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Ramos A, Rabasa F, Mendoza L, Cardenete J, Gill P, Morilla A, Cardona D, Pérez A. Differences in Glycemic Control in Diabetic and Non-diabetic Patients with Parenteral Nutrition Using a Basal plus Correction Insulin Regimen: An Observational, Retrospective Study. Diabetes Ther 2018; 9:1359-1367. [PMID: 29725969 PMCID: PMC5984936 DOI: 10.1007/s13300-018-0433-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Hyperglycemia is a frequent complication of parenteral nutrition (PN) in patients both with and without diabetes mellitis (DM). The aim of this study was to evaluate the quality of glucose control achieved with basal plus-correction insulin in surgical patients with and without a history of DM receiving PN. METHODS Retrospective evaluation of a protocol applied during the period of January 2013-December 2015. The insulin dose was started at 0.4 and 0.3 IU/kg/day in patients with previous DM and without a history of DM, respectively, and the target blood glucose (BG) was < 180 mg/dl. Mean BG levels, insulin total daily dose (TDD) and hypoglycemic (< 70 mg/dl) events on different days of PN were also evaluated. RESULTS Forty-one patients with previous type 2 DM and 39 without DM were evaluated. Glycemic control in both groups was as follows: during the first 48 h (230.4 ± 67 vs. 189.4 ± 38 mg/dl, p = 0.002); at the midpoint (224.6 ± 58 vs. 181.3 ± 27 mg/dl, p = 0.003); 48 h before ending TPN (196.4 ± 43 vs. 169.8 ± 40 mg/dl, p = 0.004). Insulin TDD was 0.5 ± 0.3 U/kg/day in patients with DM and 0.37 ± 0.3 units/kg/day in those without DM (p < 0.05). A total of 18 patients experienced hypoglycemic events, without differences between the groups. CONCLUSION A basal-correction insulin regimen is an alternative method for managing hyperglycemia in non-critically ill surgical patients on PN.
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Affiliation(s)
- Analía Ramos
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Barcelona, Spain
| | - Fernanda Rabasa
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Barcelona, Spain
| | - Lilian Mendoza
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Barcelona, Spain
| | - Joana Cardenete
- Department of Pharmacy Service, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Pedro Gill
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Barcelona, Spain
| | - Alba Morilla
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Barcelona, Spain
| | - Daniel Cardona
- Department of Pharmacy Service, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Pérez
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain.
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Tang V, Morsy M, Chemla E. Using Arteriovenous Fistulae as a Dual Access for Hemodialysis and Total Parenteral Nutrition Administration is Feasible with a Good Outcome: A Case Series. J Vasc Access 2018. [DOI: 10.1177/112972980700800415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
End stage renal failure patients requiring long term total parenteral nutrition (TPN) often have multiple central line placements due to line infection or occlusion. Sometimes this can cause central venous stenosis or even occlusion. We present three cases in this consecutive series, in which we have successfully used arteriovenous fistulae for both hemodialysis and long term TPN administration as an alternative route without any complications. We therefore think that native AVF and grafts can be used as dual access for hemodialysis and TPN administration provided careful case selection, counselling and follow-up.
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Affiliation(s)
- V.C.Y Tang
- South West Thames, Surrey and Sussex Renal Transplant Network, London - UK
| | - M.A Morsy
- South West Thames, Surrey and Sussex Renal Transplant Network, London - UK
| | - E.S. Chemla
- South West Thames, Surrey and Sussex Renal Transplant Network, London - UK
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Gambotti L, Pérol D, Frering B, Kaemmerlen P, Coronel B, Sebban H, Bulso V, Bachelot V, Chauvin F, Bachmann P. Safety of Percutaneous Internal Jugular Catheterization in Cancer Patients: Prospective Observational Study. J Vasc Access 2018; 5:161-7. [PMID: 16596560 DOI: 10.1177/112972980400500405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose To determine predictors for failure and early complications of percutaneous internal jugular catheterization (IJC) in cancer patients. Methods Six hundred and thirty consecutive cancer patients who required central venous catheterization were included in a prospective observational study. The rates of failure (defined as the intervention of a second physician and/or failure at initial insertion site) and of early complications were prospectively ascertained. Logistic regression analysis estimated odds ratio (OR) and 95% confidence intervals (95% CI) for independent predictors for failure and early complications of percutaneous IJC. Results The failure rate was 6.7%, and the early complication rate was 6.7%. In multivariate analysis, left-side initial catheterization (p<0.01), prior catheterization at the same site (p=0.001) and physician inexperience (p<0.0001) were independently associated with failure. Placement requiring more than one needle pass (p<0.01 for two and p<0.0001 for three and more) and absence of fluoroscopy (p<0.0001) were independently associated with early complications. Conclusions Percutaneous IJC is a valid option in the central venous catheterization of cancer patients due to its reliability and safety. Skilled physicians must manage difficult placements. If placement requires more than one needle pass or is made without fluoroscopy, patients must be carefully followed for potential complications.
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Affiliation(s)
- L Gambotti
- Department of Public Health, Léon Bérard Center, Lyon, France
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Abstract
The aim of this article is to provide an overview of what parenteral nutrition (PN) is and when its use is required. It will describe the process of nutritional assessment, and considerations when choosing venous access. The different approaches to provision of PN solutions in hospital will be discussed. Catheter-related and metabolic complications can occur during delivery of PN; there will be a discussion of the different types of complications and how these can be avoided or minimised. Finally, the pivotal role of the nurse in the assessment and ongoing care of patients who require PN will be highlighted, including skills required to administer PN safely.
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Affiliation(s)
- Nicky Wyer
- Senior Specialist Dietitian, University Hospitals Coventry and Warwickshire NHS Trust, Coventry
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Kumar RK, Singhal A, Vaidya U, Banerjee S, Anwar F, Rao S. Optimizing Nutrition in Preterm Low Birth Weight Infants-Consensus Summary. Front Nutr 2017; 4:20. [PMID: 28603716 PMCID: PMC5445116 DOI: 10.3389/fnut.2017.00020] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/29/2017] [Indexed: 12/19/2022] Open
Abstract
Preterm birth survivors are at a higher risk of growth and developmental disabilities compared to their term counterparts. Development of strategies to lower the complications of preterm birth forms the rising need of the hour. Appropriate nutrition is essential for the growth and development of preterm infants. Early administration of optimal nutrition to preterm birth survivors lowers the risk of adverse health outcomes and improves cognition in adulthood. A group of neonatologists, pediatricians, and nutrition experts convened to discuss and frame evidence-based recommendations for optimizing nutrition in preterm low birth weight (LBW) infants. The following were the primary recommendations of the panel: (1) enteral feeding is safe and may be preferred to parenteral nutrition due to the complications associated with the latter; however, parenteral nutrition may be a useful adjunct to enteral feeding in some critical cases; (2) early, fast, or continuous enteral feeding yields better outcomes compared to late, slow, or intermittent feeding, respectively; (3) routine use of nasogastric tubes is not advisable; (4) preterm infants can be fed while on ventilator or continuous positive airway pressure; (5) routine evaluation of gastric residuals and abdominal girth should be avoided; (6) expressed breast milk (EBM) is the first choice for feeding preterm infants due to its beneficial effects on cardiovascular, neurological, bone health, and growth outcomes; the second choice is donor pasteurized human milk; (7) EBM or donor milk may be fortified with human milk fortifiers, without increasing the osmolality of the milk, to meet the high protein requirements of preterm infants; (8) standard fortification is effective and safe but does not fulfill the high protein needs; (9) use of targeted and adjustable fortification, where possible, helps provide optimal nutrition; (10) optimizing weight gain in preterm infants prevents long-term cardiovascular complications; (11) checking for optimal weight and sucking/swallowing ability is essential prior to discharge of preterm infants; and (12) appropriate counseling and regular follow-up and monitoring after discharge will help achieve better long-term health outcomes. This consensus summary serves as a useful guide to clinicians in addressing the challenges and providing optimal nutrition to preterm LBW infants.
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Affiliation(s)
| | - Atul Singhal
- Institute of Child Health, UCL, London, United Kingdom
| | | | | | - Fahmina Anwar
- Medical and Scientific Affairs, Nestle Nutrition, South Asia Region, Gurgaon, India
| | - Shashidhar Rao
- Medical and Scientific Affairs, Nestle Nutrition, South Asia Region, Gurgaon, India
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Oghazian MB, Javadi MR, Radfar M, Torkamandi H, Sadeghi M, Hayatshahi A, Gholami K. Effectiveness of regular versus glargine insulin in stable critical care patients receiving parenteral nutrition: a randomized controlled trial. Pharmacotherapy 2015; 35:148-57. [PMID: 25689245 DOI: 10.1002/phar.1546] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVE To compare the effectiveness and safety of two glycemic control regimens in stable critical care patients receiving parenteral nutrition (PN). DESIGN Prospective, randomized open-label clinical trial. METHODS Eligible postoperative critical care patients in the ICU began PN on the first to the seventh day of ICU admission. The PN admixture included regular insulin, in doses sufficient to maintain 3 or more goal blood glucose (BG) levels between 110 and 180 mg/dl. After 3 to 5 days of PN containing regular insulin, patients were randomized to 3 more days of regular insulin at the same dose or 80% of their total daily regular insulin dose provided in PN solution as glargine insulin. Capillary BG monitoring was performed every 6 hours. RESULTS Twenty one patients were randomized to each treatment group. Median APACHE II scores were not significantly different between the two groups within the first 24-hour of ICU admission. There were no significant differences between the two groups at day 3 for mean daily dextrose (306.9 ± 46.2 vs. 305.2 ± 52.2 g; p=0.913) or insulin (18.3 ± 8.8 vs. 19.5 ± 10.0 units; p=0.696) doses. The percentage of BG values in the goal (110-180 mg/dl), hyperglycemic (> 180 mg/dl), and hypoglycemic (< 70 mg/dl) BG levels were similar between the two groups (69.0% vs. 66.7%, p=0.567; 11.9% vs. 11.1%, p=0.780; 0% vs. 1.6%, p=0.124, respectively). Mean daily BG levels were not significantly different between the two groups on each of the 3 study days (day 1: 140 ± 20 vs. 131 ± 25 mg/dl, p=0.194; day 2: 136 ± 20 vs. 140 ± 18 mg/dl, p=0.498; day 3: 142 ± 15 vs. 140 ± 19 mg/dl; p=0.741). CONCLUSION These data suggest that, compared with regular insulin added to PN, glargine insulin results in similar glycemic control and rates of hyperglycemia and hypoglycemia in stable critical care patients.
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Affiliation(s)
- Mohammad Bagher Oghazian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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8
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Abstract
BACKGROUND Hyperemesis gravidarum complicates 0.5-2.0% of pregnancies and may lead to substantial nutritional deficiencies. Total parenteral nutrition can be used in severe cases in an attempt to avoid such deficiencies. Rarely, thiamine deficiency resulting in Wernicke encephalopathy occurs, with significant maternal morbidity. CASE We present the case of a 30-year-old woman with hyperemesis gravidarum at 13 4/7 weeks of gestation treated with prolonged total parenteral nutrition that lacked thiamine supplementation, resulting in iatrogenic Wernicke encephalopathy. After high-dose intravenous thiamine repletion, she experienced slow resolution of her symptoms. CONCLUSION Pregnancies complicated by hyperemesis gravidarum treated with total parenteral nutrition represent potential high-risk clinical scenarios for thiamine deficiency. Compositions of total parenteral nutrition are not standardized. Thus, physicians must confirm repletion of all essential components to avoid significant morbidity.
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Durkin MJ, Dukes JL, Reeds DN, Mazuski JE, Camins BC. A Descriptive Study of the Risk Factors Associated With Catheter-Related Bloodstream Infections in the Home Parenteral Nutrition Population. JPEN J Parenter Enteral Nutr 2015; 40:1006-13. [PMID: 25596210 DOI: 10.1177/0148607114567899] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/10/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is increasingly used for nutrition support after patients are discharged from the hospital. Catheter-related bloodstream infections (CR-BSI) are a common and potentially fatal complication of HPN. The risk factors for development of CR-BSI in the outpatient setting are poorly understood. METHODS We conducted an observational, retrospective study of 225 patients discharged from Barnes-Jewish Hospital on HPN between January 1, 2007, and December 31, 2009. HPN complications were defined as any cause that led to either premature discontinuation of HPN therapy or catheter replacement. CR-BSI events were identified by provider documentation. We calculated the overall complication rate and the complication rate specifically due to CR-BSI. Backward stepwise Cox regression analyses were used to assess for independent predictors of catheter-related complications. RESULTS In total, 111 of 225 patients (49%) developed complications while receiving HPN (incidence = 5.06 episodes/1000 catheter days). Sixty-eight of 225 patients (30%) required catheter removal for CR-BSI (incidence = 3.10 episodes/1000 catheter days). Independent predictors of line removal specifically due to infection included anticoagulant use, ulcer or open wound, and Medicare or Medicaid insurance. The following risk factors were associated with catheter-associated complications and/or CR-BSI: the presence of ulcers, the use of systemic anticoagulants, public insurance (Medicare or Medicaid), and patient age. Independent predictors of line removal for any complication included age and anticoagulant use. CONCLUSION Catheter-related complications were extremely common in patients receiving HPN. Healthcare providers caring for individuals who require HPN should be aware of risk factors for complications.
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Affiliation(s)
- Michael J Durkin
- Department of Medicine, Division of Hospital Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Jonathan L Dukes
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, Missouri, USA
| | - Dominic N Reeds
- Department of Medicine, Division of Geriatrics and Nutritional Science, Washington University in St Louis, St Louis, Missouri, USA
| | - John E Mazuski
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Bernard C Camins
- Department of Medicine, Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
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Ueno T, Wada M, Hoshino K, Uemoto S, Taguchi T, Furukawa H, Fukuzawa M. Impact of Intestinal Transplantation for Intestinal Failure in Japan. Transplant Proc 2014; 46:2122-4. [DOI: 10.1016/j.transproceed.2014.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Bachand MP, Hébuterne X, Schneider SM. Les thromboses veineuses en nutrition parentérale à domicile : de la prévention au traitement. NUTR CLIN METAB 2013. [DOI: 10.1016/j.nupar.2013.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Impact of pediatric intestinal transplantation on intestinal failure in Japan: findings based on the Japanese intestinal transplant registry. Pediatr Surg Int 2013; 29:1065-70. [PMID: 23982390 DOI: 10.1007/s00383-013-3392-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION We assessed the impact of intestinal transplantation on Japanese pediatric patients with intestinal failure with data from the Japanese intestinal transplant registry. METHODS Standardized forms were sent to all known intestinal transplantation programs, requesting information on transplants performed between 1996 and June 30, 2012. Patients younger than 18 years were analyzed. Patient and graft survival estimates were obtained using the Kaplan-Meier method. RESULTS Of the 14 intestinal transplants, 4 were deceased and 10 were living donor transplants. The primary indications were: short gut syndrome (n = 7), intestinal functional disorder (n = 6), and re-transplantation (n = 1). The overall 1- and 5-year patient survival rates were 77 and 57%, respectively. In transplants performed after 2006 (n = 6), the one-year patient survival rate was 83%, and the 5-year survival rate was 83%. Graft one- and 5-year survival rates were 83 and 83%, respectively. The living-related transplant survival rate was 80% at 1 year and 68% at 2 years, compared to 67 and 67% for cadaveric transplant recipients. There were no statistically significant differences in patient (p = 0.88) and graft (p = 0.76) survival rates between living donor and cadaveric transplant recipients. All current survivors discontinued PN. CONCLUSION Intestinal transplantation has become an effective therapy for patients with intestinal failure who cannot tolerate PN.
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Onar P, Yildiz BD, Yildiz EA, Besler T, Abbasoglu O. Olive Oil‐Based Fat Emulsion Versus Soy Oil‐Based Fat Emulsion in Abdominal Oncologic Surgery. Nutr Clin Pract 2011; 26:61-65. [DOI: 10.1177/0884533610392920] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
In parenteral nutrition (PN), essential fatty acids are provided by soy oil‐based fat emulsions, which may exert adverse effects on the immune system and lipid peroxidation. Olive oil ‐based fat emulsions have been said to prevent these undesired effects. This study compares effects of olive oil ‐ and soy oil ‐based fat emulsions in 22 patients who underwent abdominal surgery for cancer. The first group (n = 10) received soy oil ‐based fat emulsion; the second group (n = 10) received olive oil ‐based fat emulsion. Body temperature, body mass index, (BMI) and biochemical variables were measured on days 0 and 7. There were no differences between the groups with regard to BMI or temperature. On day 7, the first group (compared with day 0) had significant increases in plasma alkaline phosphatase (81.70 ± 16.03 vs 117.60 ± 11.1), γ‐glutamyl transferase (39.90 ± 15.40 vs 137.70 ± 24.09), and mean body temperature (36.72°C ± 0.14°C vs 37.20°C ± 0.17°C) (P < .01). Second group had increases in alkaline phosphatase (85.80 ± 13.46 vs 147.20 ± 34.17), γ‐glutamyl transferase (48.40 ± 12.86 vs 129.40 ± 42.03), total protein (5.14 ± 0.19 vs 6.06 ± 0.49), and albumin (2.62 ± 0.14 vs 3.00 ± 0.18) (P < .05). Changes in thiobutyric acid levels were not statistically significant in either group. In postoperative cancer patients, olive oil‐based fat emulsion had similar effects on BMI, body temperature, biochemical values, and thiobutyric acid levels as soy oil‐based fat emulsions.
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The Role of CT-guided Percutaneous Gastrostomy in Patients With Clinically Severe Obesity Presenting With Complications After Bariatric Surgery. Surg Laparosc Endosc Percutan Tech 2010; 20:299-305. [DOI: 10.1097/sle.0b013e3181f333f8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hartl WH, Jauch KW, Parhofer K, Rittler P. Complications and monitoring - Guidelines on Parenteral Nutrition, Chapter 11. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2009; 7:Doc17. [PMID: 20049074 PMCID: PMC2795374 DOI: 10.3205/000076] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Indexed: 01/04/2023]
Abstract
Compared to enteral or hypocaloric oral nutrition, the use of PN (parenteral nutrition) is not associated with increased mortality, overall frequency of complications, or longer length of hospital stay (LOS). The risk of PN complications (e.g. refeeding-syndrome, hyperglycaemia, bone demineralisation, catheter infections) can be minimised by carefully monitoring patients and the use of nutrition support teams particularly during long-term PN. Occuring complications are e.g. the refeeding-syndrome in patients suffering from severe malnutrition with the initiation of refeeding or metabolic, hypertriglyceridemia, hyperglycaemia, osteomalacia and osteoporosis, and hepatic complications including fatty liver, non-alcoholic fatty liver disease, cholestasis, cholecystitis, and cholelithiasis. Efficient monitoring in all types of PN can result in reduced PN-associated complications and reduced costs. Water and electrolyte balance, blood sugar, and cardiovascular function should regularly be monitored during PN. Regular checks of serum electrolytes and triglycerides as well as additional monitoring measures are necessary in patients with altered renal function, electrolyte-free substrate intake, lipid infusions, and in intensive care patients. The metabolic monitoring of patients under long-term PN should be carried out according to standardised procedures. Monitoring metabolic determinants of bone metabolism is particularly important in patients receiving long-term PN. Markers of intermediary, electrolyte and trace element metabolism require regular checks.
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Affiliation(s)
- W H Hartl
- Dept. Surgery Grosshadern, University Hospital, Munich, Germany
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Servia L, Schoenenberger JA, Trujillano J, Badia M, Rodríguez-Pozo A. [Risk factors of the hepatic dysfunction associated with parenteral nutrition]. Med Clin (Barc) 2009; 132:123-7. [PMID: 19211070 DOI: 10.1016/j.medcli.2008.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 02/13/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this study is to describe the incidence of hepatic dysfunction (HD) in our hospital and evaluate the possible risk factors associated with HD development as an improvement of the caring process received by patients treated with parenteral nutrition (PN). PATIENTS AND METHOD A prospective study of patients (n=994) who required PN during the period 2000-2004. HD is the identification of an increase above 1,5 of the top reference value of alkaline phosphatase (40-450U/l) and gamma glutamyl transpeptidase (11-49U/l) associated with an increase of transaminases (5-32U/l) and a total bilirrubin higher than 1,2mg/dl. RESULTS The incidence of HD was 4,9% (n=49). Days with PN were significantly higher in the HD group: median (interquartile range): 30 (20-59) vs 15 (8-25) days (p<0.001). In the univariated HD analysis, the variables that reached significant odds ratio were: the critical patient condition, the PN duration, the total calorie contribution higher than 25kcal/kg, to exceed 3g of carbohydrates/kg, to administer more than 0.8g/kg of lipids and to exceed 0.16g of nitrogen/kg. In the multivariated analysis, the variables selected as independent risk factors were: to exceed 3 weeks of PN, to be a critical patient and a contribution over 0.16g of nitrogen/kg. CONCLUSIONS The present profiles of the patients who will develop HD are those with prolonged PN. These patients undergo processes and critical therapy, where the specialists must monitor, not only calorie contribution, carbohydrates or lipids, but proteins as well.
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Affiliation(s)
- Luis Servia
- Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lleida, España.
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Fuentes-Orozco C, Cervantes-Guevara G, Muciño-Hernández I, López-Ortega A, Ambriz-González G, Gutiérrez-de-la-Rosa JL, Gómez-Herrera E, Hermosillo-Sandoval JM, González-Ojeda A. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis. JPEN J Parenter Enteral Nutr 2008; 32:403-11. [PMID: 18596311 DOI: 10.1177/0148607108319797] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The effect of parenteral GLN on recovery from severe acute pancreatitis has not been thoroughly investigated. The aims of this study were to determine whether parenteral GLN improves nutrition status and immune function, and to determine its ability to reduce morbidity and mortality in patients with this condition. METHODS In a randomized clinical trial, 44 patients with severe acute pancreatitis were randomly assigned to receive either standard PN (n = 22) or l-alanyl-l-glutamine-supplemented PN (n = 22) after hospital admission. Nitrogen balance, counts of leukocytes, total lymphocytes, and CD4 and CD8 subpopulations, and serum levels of immunoglobulin A, total protein, albumin, C-reactive protein, and serum interleukin (IL)-6 and IL-10 were measured on days 0, 5, and 10. Hospital stay, infectious morbidity, and mortality were also evaluated. RESULTS Demographics, laboratory characteristics, and pancreatitis etiology and severity at entry to the study were similar between groups. The study group exhibited significant increases in serum IL-10 levels, total lymphocyte and lymphocyte subpopulation counts, and albumin serum levels. Nitrogen balance also improved to positive levels in the study group and remained negative in the control group. Infectious morbidity was more frequent in the control group than in the study group. The duration of hospital stay was similar between groups, as was mortality. CONCLUSION The results suggest that treatment of patients with GLN-supplemented PN may decrease infectious morbidity rate compared with those who treated with nonenriched PN.
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Affiliation(s)
- Clotilde Fuentes-Orozco
- Medical Research Unit in Clinical Epidemiology, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
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Sahin H, Mercanligil SM, Inanç N, Ok E. Effects of glutamine-enriched total parenteral nutrition on acute pancreatitis. Eur J Clin Nutr 2007; 61:1429-34. [PMID: 17311061 DOI: 10.1038/sj.ejcn.1602664] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM This study was performed to determine the effects of glutamine enriched total parenteral nutrition (TPN) on the patients with acute pancreatitis (AP). METHOD Forty patients with AP, who had Ranson's score between 2 and 4 received either standard TPN (control group) or TPN with glutamine (treatment group). The patients in the treatment group received TPN containing 0.3 g/kg/days glutamine. At the end of the study, patients were evaluated for nutritional and inflammatory parameters, length of TPN and length of hospital stay. RESULTS The length of TPN applications were 10.5+/-3.6 days and 11.6+/-2.5 days, and the length of hospital stays were 14.2+/-4.4 and 16.4+/-3.9 days for the treatment and control groups (NS), and the complication rates in the treatment and control groups were 10 and 40%, respectively (P<0.05). The transferrin level increased by 11.7% in the group that received glutamine-enriched TPN (P<0.05), whereas the transferrin level decreased by 12.1% in the control group (NS). At the end of the study, slight but not significant changes were determined in both groups in fasting blood sugar, albumin, blood urea nitrogen (BUN), creatinine, total cholesterol concentrations, aspartate aminotransferase (AST), alanine transaminase (ALT) and lactate dehydrogenase (LDH) activities, leukocytes, CD(4), CD(8), serum Zn, Ca and P levels compare to the baseline levels (NS). Significant decreases were determined in serum lipase, amylase activities and C-reactive protein (CRP) levels in both groups (P<0.05). CONCLUSIONS The results of this study have shown that glutamine supplementation to TPN have beneficial effects on the prevention of complications in patients with AP.
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Affiliation(s)
- H Sahin
- Department of Nutrition and Dietetics, Ataturk School of Health, University of Erciyes, Kayseri, Turkey.
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De Marco G, Barabino A, Gambarara M, Diamanti A, Martelossi S, Guarino A. Network approach to the child with primary intestinal failure. J Pediatr Gastroenterol Nutr 2006; 43 Suppl 1:S61-7. [PMID: 16819404 DOI: 10.1097/01.mpg.0000226392.09978.6d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Intestinal failure (IF) is a rare condition resulting from short gut and other heterogeneous intestinal diseases. Major centers in Italy merged in a national network to build common diagnostic and management approaches and to investigate the natural history of IF. Gastroenterological reference centers with specific expertise in intestinal morphology, diagnosis of autoimmune conditions, intestinal microbiology and parenteral nutrition were identified to act as consultants to the network. These centers of expertise provided specific diagnostic approaches while ensuring high technical standards. The approach allowed each center to learn from a larger cohort of patient samples. A database was set up to investigate etiology, epidemiology and natural history of IF. A common diagnostic algorithm for intractable diarrhea was designed. This process was largely based on electronic communication among centers and specimen shipping. Etiologic diagnosis was obtained in almost all cases of IF secondary to severe protracted diarrhea. The study of the natural history of IF showed a close association between etiology of IF and its outcome. The natural history of IF also provided the starting point for specific therapeutic approaches to its complications such as parenteral nutrition-associated cholestasis and catheter-related sepsis. The network approach to IF provides an effective model to optimize resources and prospectively investigate the natural history of IF, essential steps to design interventions, including intestinal transplantation and improve the outcome of IF.
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Affiliation(s)
- Giulio De Marco
- Department of Pediatrics, University Federico II of Naples, Naples, Italy
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Takeyama H, Taniguchi M, Sawai H, Funahashi H, Hayakawa T, Tanaka M, Akamo Y, Sato M, Yamamoto M, Suzuki S, Manabe T. An anti-stray stylet for subclavian catheterization by the infraclavicular approach. Nutrition 2005; 21:432-7. [PMID: 15811762 DOI: 10.1016/j.nut.2004.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 07/24/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Misplacement of subclavian vein catheters has been reported. We assessed the rate of misplacement of a subclavian vein catheter with and without a novel stylet. METHODS A prospective, randomized, controlled clinical trial was conducted between September 2001 and June 2003 in a university hospital. Two hundred sixteen adult patients were enrolled to receive subclavian vein catheterization under non-emergency conditions. Patients were randomly assigned to undergo right subclavian vein catheterization with the stylet (n = 109, stylet group) or without the stylet (n = 107, control group). The rate of subclavian vein catheter misplacement was determined and risk factors for failure and complications were analyzed. RESULTS There was no incidence of catheter misplacement in the stylet group, but this occurred in 12 patients in the control group in whom the catheter was misplaced into the ipsilateral internal jugular vein (0% versus 11.2%, P = 0.0003). In multivariate analyses, use of the stylet (odds ratio = 0.062, 95% confidence interval = 0.008 to 0.495, P = 0.009) and a close to average body mass index (odds ratio = 0.73, 95% confidence interval = 0.54 to 0.98, P = 0.038) were associated with low risks of complications and failure, respectively. CONCLUSIONS This stylet is useful for decreasing the incidence of misplacement of subclavian vein catheters. Body mass index is predictive of failed vein puncture.
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Affiliation(s)
- Hiromitsu Takeyama
- First Department of Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
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Abstract
Today, there are many alternative feeding options for patients unable to eat and drink and nutrition support has become part of everyday clinical practice. Although feeding via the enteral route used to be considered optional, recent experts have re-examined the role of parenteral nutrition, and found it to be as beneficial. This article will review current practice surrounding parental nutrition, its indications and the associated complications. Successful feeding via the intravenous route relies on the selection of the appropriate intravenous access, optimum nursing care and close patient monitoring. The range of venous access options will be discussed and advantages and disadvantages identified.
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Miranda-Sanchez S, Ruiz JC, Talbotec C, Corriol O, Goulet O, Colomb V. Pathologie osseuse associée à la nutrition parentérale chez l'enfant. NUTR CLIN METAB 2004. [DOI: 10.1016/j.nupar.2004.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Reimund JM, Arondel Y, Finck G, Zimmermann F, Duclos B, Baumann R. Catheter-related infection in patients on home parenteral nutrition: results of a prospective survey. Clin Nutr 2002; 21:33-8. [PMID: 11884010 DOI: 10.1054/clnu.2001.0500] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS Central venous catheter (CVC) infection is the most frequent complication during home parenteral nutrition (HPN). We prospectively assessed incidence and catheter-related sepsis (CRS)-associated factors in the 42 adult patients enrolled in our HPN centre since its opening. METHODS Age, frequency of infusions, CVC type, autonomy or nurse/family aid, underlying disease, involved infectious organism(s), hospital stay, efficacy of antibiotic-lock and other infectious complications, were studied. RESULTS CRS occurred 39 times (3/1000 days of HPN). In 37/39 cases, it was proven by both peripheral and central blood cultures. In 56% of patients, clinical signs were discrete, delaying diagnosis. Individual factors like learning potency, underlying disease (especially chronic intestinal obstruction with bacterial overgrowth), and length of remaining colon and small intestine, were slightly associated with higher CRS incidence. Usually, one organism (S. epidermidis; 51%) was detected. A total of 14 CVC were immediately removed. In the others, antibiotic-lock was more effective in patients having tunnelled catheters (TC, 50%) than implanted devices (25%; P<0.05). Mean hospital stay was 22+/-15 days, which was influenced by 3 patients presenting associated osteomyelitis. CONCLUSIONS CRS incidence was 3/1000 days of HPN. Clinical symptoms were often discrete, suggesting importance of rigorous survey. Individual apprenticeship and risk for higher bacterial translocation seem associated to higher CRS incidence. CVC sterilization was more frequent in patients with TC.
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Affiliation(s)
- J-M Reimund
- Centre Agréé de Nutrition Parentérale à Domicile, Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Strasbourg Cedex, France
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Conceptos básicos de la nutrición enteral y parenteral. Otros abordajes terapéuticos de la malnutrición. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s0304-5412(02)70872-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Arenas-Marquez H, Anaya-Prado R, Barrera-Zepeda LM, Gonzalez-Ojeda A. Complications of central venous catheters. Curr Opin Clin Nutr Metab Care 2001; 4:207-10. [PMID: 11517354 DOI: 10.1097/00075197-200105000-00007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Central vein catheterization is frequently employed for monitoring, administration of drugs and parenteral nutrition in a variety of medical and surgical illnesses. Despite the widespread use of central vein access, both catheter-related infections and mechanical complications remain unacceptably common. In the last few years, data have become available to show that technical innovations and catheter maintenance protocols can reduce both catheter related bloodstream infections as well as mechanical complications. Future developments should be aimed at both educational intervention and biomaterials research. The former incorporates case-based instruction, problem-solving examination, and database analysis; while the latter will probably lead to a new set of catheters that are more resistant to infection and thrombosis.
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Affiliation(s)
- H Arenas-Marquez
- Specialized Surgical and Nutritional Clinic, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico.
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Bachmann P, Frering B. Catheter-related complications at the end of the century: is it time to change the technique? Clin Nutr 2001; 20:195. [PMID: 11327753 DOI: 10.1054/clnu.2000.0391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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