Appropriateness of peripheral parenteral nutrition use in adult patients at an academic medical center

Sugrue, David; Jarrell, Andrew; Kruer, Rachel; Davis, S. Lindsey; Johnson, Dachelle; Tsui, Evelyn; Snyder, Sukyee; Crow, Jessica

doi:10.1016/j.clnesp.2017.11.004

Cited by 12 publications

(10 citation statements)

References 13 publications

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“…Constatou-se apenas um paciente com essa intercorrência. Sugrue et al 17 , de forma discrepante, conduziram uma pesquisa retrospectiva com 159 pacientes em uso de NPP, observaram cerca de 43,4% (n=69) com flebite, considerando um tempo apropriado máximo de 14 dias para utilização da NPP.…”

Section: Discussionunclassified

Complicações e desfechos clínicos de pacientes em uso de nutrição parenteral em um hospital público do Distrito Federal

Granjeiro¹,

Borges²,

Fortes³

2020

Braspen J

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Introduction: Parenteral nutrition has become an effective alternative for caloric-protein supply in hospitalized patients. The objective of this study is to evaluate the use, complications and clinical outcomes of patients using parenteral nutrition. Methods: Analytical, quantitative, longitudinal, retrospective study with patients admitted to a public hospital. The variables analyzed were: sex, age, presence of malnutrition, nutritional risk, achievement of nutritional goals, reason for indication, type of access, time of use, present complications and deaths. Results: The sample consisted of 62 patients aged 55.1±17.95 years old. Total parenteral nutrition was found more frequently (61%; n=38) and used within 30 days (74%; n=28). As indicated, the postoperative period was prevalent in 45.2% (n=28) of the cases. Nutritional risk (58.1%, n=36) and malnutrition (40.3%; n=25) were prevalent. Hyperglycemia (50%; n=31) and water retention (48.4%; n=30) were the most frequent complications. The presence of water retention increased the chances of death by 3.75 times (OR=3.75; 95%IC 1.25-11.24; p=0.018). Conclusion: The indication of parenteral nutrition was prevalent in postoperative situations, in patients with nutritional risk and malnutrition. Hyperglycemia was the most observed complication and the presence of water retention associated with a higher risk of mortality when using this therapy.

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Section: Discussionunclassified

Complicações e desfechos clínicos de pacientes em uso de nutrição parenteral em um hospital público do Distrito Federal

Granjeiro¹,

Borges²,

Fortes³

2020

Braspen J

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“…Periferik PN (PPN) santral venöz yolun olası olmadığı durumlarda kullanılabilir. Ayrıca PPN kullanımının beslenme desteğinin oluşturulmasında, santral venöz yol sağlanıncaya kadar olan gecikmeleri önleyebile-ceği bildirilmiştir (12) . Fakat PPN solüsyonlarının osmolaritesi düşük olduğundan, yeterli kaloriye ulaşmak için sıklıkla büyük hacimler vermek gerekir.…”

Section: Parenteral Beslenen Hastaların Endikasyonları Ne Kadar Uygun?unclassified

How Appropriate Are the Indications for Parenteral Nutrition Patients?

Sayan¹

2020

jarss

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Bulgular: Hastanemizde altı aylık süre boyunca 333 hastaya PN uygulandığı saptandı. PN'na, beslenmeye engel kusma (%37), obstrüktif bağırsak hastalığı (%27), ağır diyare (%12) ve ağır malabsorbsiyon (%12) nedeniyle başlanmıştı. Hastaların 153 (%45.9)'üne uygun olmayan endikasyon ile başlanmıştı. Uygun olmayan endikasyon nedenleri arasında en sık doktorun konservatif olarak PN tercih etmesinin (142 olgu, %92.8) olduğu görüldü. PN başlanan hastaların 256'sı (%76.9) yetersiz kalori almaktaydı. Hastaların beslenmesinde en sık periferik parenteral nütrisyon (PPN) (155 olgu, %46.5) yol tercih edilmiş, uygun olmayan endikasyon ile PN (%40) ve yetersiz kalori ile beslenme de (%98.1) bu grupta görülmüştür. Sonuç: Herhangi bir nedenle yeterli oral veya enteral beslenemeyen hastalara, tek başına PN veya enteral nütrisyona ek olarak PN başlanmaktadır. PN ile ilgili risklerin en aza indirilmesi için PN endikasyonları iyi bilinmeli, bunun için beslenme odaklı eğitimler planlanmalıdır. Uygun olmayan endikasyon ve yetersiz kalori uygulanma riskine karşı hastane nütrisyon destek ekibi (NDE)'nin önerilerinin dikkate alınması gerektiğini düşünüyoruz.

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“…The risk of microbial contamination and following growth is greater with peripheral PN than with PN, mainly due to the lower osmolarity in peripheral PN [14]. Moreover, the risk of phlebitis and extravasation is high and causes catheter removal [15].…”

Section: Accesses For Artificial Nutritionmentioning

confidence: 99%

Pharmaceutical Aspects of Artificial Nutrition

Reber

Messerli

Stanga

et al. 2019

JCM

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Artificial nutrition, including enteral (EN) and parenteral (PN) nutrition, is indicated whenever adequate oral nutrition fails to sufficiently supply the necessary nutrients to the body. It is a convenient, efficacious, safe, and well-tolerated form of clinical nutrition in the hospital and home setting. EN is administered via nasogastric tube or ostomies while PN usually requires a central venous access for administration, straight into the blood stream. The infused nutrients can then be taken up directly by the different organs. PN is targeted as a single daily portion formulated as an oil-in-water emulsion providing the necessary substrates for the catabolic and anabolic metabolism including macro- and micronutrients and fluids. PN has a complex pharmaceutical composition—all-in-one admixture—and its compounding or ready-to-use preparation. The use of PN is more challenging and more expensive compare to the use of EN, commercially available as ready-to-use formulations. EN and concomitant medication is highly challenging. Upon incorrect handling and administration, PN is associated with potentially severe or even fatal complications, mostly relating to the central venous access (e.g., catheter-related sepsis) or to a metabolic intolerance (e.g., hyperglycemia, refeeding syndrome) because of inappropriate administration. A correct order of admixing, correct dosing, and administration of the artificial is crucial for safety and efficacy; clinical and biochemical monitoring of the patient and treatment regimen adaption are necessary. The high number of reactive solutes allow only limited stability of a ready-to-use PN admixture. The potential for numerous incompatibilities and interactions renders PN admixtures generally unsuitable as drug vehicle. Laboratory compatibility and stability testing and pharmaceutical expertise are a prerequisite to define the PN composition including nutrients or even drugs admixed to define the appropriate and individualized nutrition and medication regimen. The aim of this narrative review is to present the actual state-of-the-art to deliver best quality artificial nutrition with special regard on pharmaceutical aspects such as instabilities, incompatibilities, and concomitant co-medication.

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Appropriateness of peripheral parenteral nutrition use in adult patients at an academic medical center

Cited by 12 publications

References 13 publications

Complicações e desfechos clínicos de pacientes em uso de nutrição parenteral em um hospital público do Distrito Federal

Complicações e desfechos clínicos de pacientes em uso de nutrição parenteral em um hospital público do Distrito Federal

How Appropriate Are the Indications for Parenteral Nutrition Patients?

Pharmaceutical Aspects of Artificial Nutrition

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