100 Patient-Yea f Ambulatory Home Total Parenteral Nutrition

Abstract

More than 100 patient-years' experience has been acquired in the treatment of 133 patients with ambulatory home total parenteral nutrition (TPN) between May 1974 and December 1983. Indications for chronic or permanent home TPN include short bowel syndrome, malabsorption, scleroderma, and vasoactive intestinal polypeptide syndrome. Indications for acute or temporary home TPN include Crohn's disease, malignancies, gastrointestinal fistulas, ulcerative colitis, anorexia nervosa, and numerous other disorders. Eighty-two patients in the acute group were treated primarily with percutaneously placed standard subclavian catheters and 51 patients in the chronic group have been treated thus far with implanted silicone rubber, Dacron-cuffed catheters for a cumulative total of 38,939 patient days. Of the 125 implanted catheters, 115 were placed in the superior vena cava and ten in the inferior vena cava for an average duration of 250 catheter-days, the longest single catheter remaining in situ for more than 8 1/2 years. Catheter-related sepsis occurred 33 times with the implanted catheters, or once every 2.6 catheter-years. One hundred and fourteen temporary catheters were placed percutaneously in the superior vena cava via a subclavian vein for an average duration of 68 days, the longest single catheter remaining in situ for 213 days. Catheter-related sepsis occurred seven times, equivalent to one episode per 3 catheter-years. Total catheter-related complications were quite infrequent and were directly related to duration of catheterization. They included venous thrombosis (12), clotted catheter (11), catheter failure or rupture (8), catheter compression (5) and inadvertent catheter removal (4). Twenty-six catheters were repaired or spliced in situ when the external segment was accidentally damaged or deteriorated secondary to long-term material fatigue. One remarkable patient has been maintained exclusively by TPN originally as an inpatient and subsequently as an outpatient for the entire 13 years of his life.

Immediate and long-term complications of prolonged-venous-access devices (PVAD): A comparison between surgical cutdown and percutaneous techniques

“…A presumable defect of the material induced us to report this to our hospitalÕs health administration as a potential adverse event, though exerting excessive force during the flushing of the system might also be responsible for rupture, especially in catheters suffering from early obstruction by the fibroconnective coating deriving from any undissolved fibrin sleeve. Totally implantable venous access devices for mediumand long-term therapeutic uses have now become indispensable in the treatment of not only neoplastic disease, but also infections [22] and malnutrition [23], as well as for intravenous sampling [24] and pain control in cancer patients. The advent of these devices immediately supplanted the use of peripheral veins for such supportive treatment, which led to a progressive exhaustion of the vessels concerned.…”

Short Bowel Syndrome: Intestinal Adaptation and Medical Therapy

“…Perhaps the greatest advance in sup, portive therapy o f sh o rt bowe l syndrome has been the introduction of total parenteral nutrition (10)(11)(12)94). T o ta l parenter a l nutritio n allows provision of calories to a patient unable to tolerate oral feeding and is responsible for the increase in patient survival with short bowel syndrome.…”

“…T o ta l parenter a l nutritio n allows provision of calories to a patient unable to tolerate oral feeding and is responsible for the increase in patient survival with short bowel syndrome. It provides time while intestinal adaptation occurs, and in the case of extreme shore bowel can provide all calories and n utrients indefinitely (94,95). T otal parenteral nutrition is not without its problems.…”

“…T otal parenteral nutrition is not without its problems. Venous access on a long term basis may be d ifficult due to recurrent sepsis and veno us obstruct ion ( 94). Also, long term total parenteral n utrition especially in the ped iatric population leads to liver fail ure from cho lescasis (96,97).At present, the main causes of death in the pediatric shore bowel population are sepsis and liver fai lure seconJary to total parenteral nutrition (97).…”

Home Parenteral Nutrition Therapy in Seven Patients with Anorexia Nervosa: The Role and Indications

“…Home parenteral nutrition (HPN) is a well-established intervention that can sustain life in patients with gastrointestinal failure or cancer. In Western countries, HPN has been used for patients with AN since the 1980s (5). It is difficult to determine whether patients with AN can successfully use HPN, as there are only a few reports on HPN in patients with AN, and the role and indications for HPN therapy in such studies are mostly not discussed (6,7).…”