Peripheral vein complications in patients receiving amino acid/dextrose solutions

An Evaluation of Peripheral Essential Amino Acid Infusion following Major Surgery

To assess postoperative progress 43 patients undergoing major abdominal procedures were randomized to be given normal postoperative electrolyte solutions alone or with the addition of 400 ml of essential amino acids. Postoperative measurements confirmed a nitrogen retention significant at 0.1%. Decreased breakdown of muscle was also shown by measuring the upper arm muscle circumference and by following the grip strength. Those treated had no significant muscle loss postoperatively but there was significant loss in those not receiving amino acids. The intravenous cannulae survived equally well in both groups. There was no demonstrable difference in the overall clinical progress.

Nutrition in the perioperative patient

The association of malnutrition with surgical morbidity and mortality is well recognized. The question of whether this relationship is causal or simply an association in sick patients has been hotly debated. The field of nutrition support has grown out of the belief that correcting malnutrition will modify associated risks for poor outcome. It has been easier to substantiate this belief in some clinical situations than in others. The evidence for nutrition support during the perioperative period is reviewed and recommendations are made about where nutrition support is most useful and where it may be counterproductive. Some of the important unanswered questions about perioperative nutrition support are raised.

AGA technical review on parenteral nutrition

This literature review and the recommendations therein were prepared for the American Gastroenterological Association Clinical Practice and Practice Economics Committee. The paper was approved by the Committee on September 13, 2001, and by the AGA Governing Board on May 18, 2001.

Incidence of phlebitis in peripheral parenteral nutrition: Effect of the different nutrient solutions

To determine the influence of peripheral parenteral nutrition (PPN) on the incidence of phlebitis and the effect of simultaneous infusion of lipid emulsion, 68 surgical patients were assigned randomly to 3 nutrition groups: (1) amino-acid 4% solution and dextrose 8% (AA + DX) + Intralipid (IL) 10% in the ratio 1.5:1 (2) AA + DX and IL 20% in the ratio 3:1 (3) AA + DX alone. Group 4 (control group) consisted of 25 patients receiving maintenance solutions and iso-osmotic drugs. No filters were used. The cannulae were studied for 72 hours and the cannula sites were evaluated daily for phlebitis. Mean age of patients was 52.3 +/- 17.7 years, with a similar sex ratio in the 4 groups. One hundred and twenty-five cannulae were studied. At 72 h, the following cumulated phlebitis rates were recorded: 22% in Group 1 (712 mOsm/L), 48% in Group 2 (802.5 mOsm/L), 44% in Group 3 (920 mOsm/L) and 26% in Group 4 (260-314 mOsm/L). The phlebitis incidence was similar in groups 1 and 4 (control) throughout the study. Both Groups 2 and 3 had higher phlebitis rates on days 2 and 3 (II: p < 0.05, III: p < 0.01). It is concluded that PPN with simultaneous IL 10% in the ratio 1.5:1 is no more phlebogenic than the usual maintenance solutions during the first 72 h. This is probably due to the lower osmolality and lower DX and K concentrations of the solution with IL 10%. Intralipid 20% does not have the same protective venous effect. The lower complication rate, the limited need for nursing, and lower costs compared to central parenteral nutrition, make PPN a safe nutrition technique for up to 10 days in patients needing no volume restriction.

Concentration guidelines for parenteral antibiotics in fluid-restricted patients

A guideline for the preparation of peripherally administered antibiotics in fluid-restricted patients was developed. A maximum osmolality of 560 mOsmol/kg was selected since this corresponds to the theoretical osmolality of dextrose 5% in NaCl 0.9%, a solution commonly administered peripherally without significant incidence of phlebitis. Percentage concentrations corresponding to 560 mOsmol/kg of 26 intravenous antibiotics were calculated using sodium chloride equivalents. The antibiotics were reconstituted using sterile water, dextrose 5%, and NaCl 0.9% to provide an osmolality of 560 mOsmol/kg. The resulting solutions were measured for osmolality using a freezing-point depression osmometer. A total of 78 solutions were prepared and measured in triplicate. Of the 78 measured osmolalities, 67 (86 percent) were within 20 percent of the desired 560 mOsmol/kg. Only two osmolalities were more than 10 percent above the projected value. The percentage concentrations of 26 antibiotics in three solutions corresponding to 560 mOsmol/kg are presented. A method is also provided for tailoring concentrations to achieve desired osmolalities other than 560 mOsmol/kg.

A key to the literature of total parenteral nutrition: update 1987

This comprehensive bibliography is intended to enhance the education of the practitioner, student, and academician in the area of parenteral nutrition. This bibliography is not all-inclusive but serves as an update from the original published in 1983. Of particular note in this work is the addition of topics that reflect a growing interest in medical specialties with regard to patient nutritional status and support.

The delivery of nutritional support. A potpourri of new devices and methods

With continued interest and increasing awareness of nutritional support to patients, both hospitalized and at home, many new developments in the field of devices and methods of delivering nutritional support have occurred. The indications, methods of use, and the associated complications related to feeding via nasogastric tube, tube esophagostomy, gastrostomy, and jejunostomy in the light of new devices and methods are outlined. The authors' experience shows that postoperative enteral feeding is a reliable and efficient method of providing supportive nutrition, provided the appropriate patients are selected. Home enteral nutritional support via gastrostomy allows stable cancer patients to maintain their nutritional status and enjoy life independent of the hospital setting for an extended period of time. When feeding via the gastrointestinal tract is neither feasible nor desirable, for both short-term and long-term nutritional support, access to the central venous system becomes necessary because peripheral vein feeding has limited cost-effectiveness. Delivery of nutrients into the superior vena cava by long antecubital catheters has been advocated, and the use of Hickman/Broviac catheters, instead of conventional subclavian catheters, is becoming an increasingly common practice. Experience with the use of arteriovenous fistulae and the Infuse-A-Port (Infusaid Corp.) are reviewed; the method used for declotting infected and thrombosed catheters is outlined. Current trends in the use of three-liter bags containing a fat emulsion with glucose and amino acids are mentioned.