Terapia nutricional parenteral domiciliar: perfil epidemiológico e prevalência das principais complicações em um serviço privado de Brasília, DF

Abstract

Introduction: Home parenteral nutrition (HPN) is useful for patients with intestinal failure (IF), defined as gastrointestinal insufficiency to sustain nutrition or hydration without intravenous support. IF can be transitory, subacute or chronic, for this last one HPN is indicated. Objective: Epidemiology profile analysis of patients in a private setting in Brasilia, DF, Brazil, using HPN and its complications (infections, metabolic and hepatic). Methods: Retrospective study, using data base analysis of patients using HPN between October 2012 and May 2019. Results: Analysis of 22 patients, mean age of 52 years old, female gender prevalence (54.5%). IF causes: gastrointestinal tract neoplasm (44%), short intestine syndrome (12%), Crohn’s disease (8%). In total, 2.781 bag of HPN were used. The central lines catheters were PICC® (85.36%) and Hickman® (13.87%). Primary bloodstream infection (CLABSI) was present in 1.43 to 1.000 catheters/day and the pathogens isolated by cultures were: Gram positive coccos (50%); Gram negative bacilli (25%); fungi (25%). Prophylactic lock therapy was used in 50% of the patients, hyperglycemia occurred in 31.81% and 36.36% had hepatic dysfunction. Complex and balanced lipid emulsion (CBLE) containing soya, olive and fish oil was used in 95.4% of the patients. The overall mortality was 63.6%, reducing to 26% when the oncologic patients were excluded. Intestinal recovery was present in 24%. Discussion: HPN has benefits and complications; the last ones can be reduced by the presence of a multidisciplinary team associated to patients and their caregivers training. We found CLABSI prevalence similar to literature and by using lock therapy we might reduce it. Avoiding caloric overload, using CBLE and preferring cyclic infusion can prevent liver disease. Conclusion: The use of HPN has increased in the last decade, especially due to its capability of promote intestinal rehabilitation and improve quality of life. For an optimized, efficient and secure treatment a skilled team is mandatory.