Total Parenteral Nutrition Catheter Sepsis: Impact of the Team Approach

Faubion, Walter C.; Wesley, John R.; Khalidi, Nabil; Silva, Joseph

doi:10.1177/0148607186010006642

Cited by 155 publications

(58 citation statements)

References 9 publications

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“…[47][48][49][50][51] As outlined above, maintaining low sepsis rates requires careful catheter care protocols, with multiple studies reiterating the importance of a multidisciplinary nutrition support team in reducing CVC-related sepsis. 45,[52][53][54] The patient is key to minimising CVC-related sepsis rates at home. While patients accessing their line more frequently during the week may be at higher risk than those who receive PN less frequently, 55 with approximately 20% of patients on HPN are responsible for around 75% of the total number of CVC-related sepsis episodes.…”

Section: Complications Of Long-term Pnmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

140

108

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SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

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Section: Complications Of Long-term Pnmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

140

108

View full text Add to dashboard Cite

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“…The problems above highlight the fact that physicians have minimal training and experience in nutritional support, and consequently this has led to the development of multidisciplinary nutrition support teams in many healthcare facilities [11] . Although a team approach to artificial feeding seems to be more advantageous when compared with a less organized approach by those without expertise [12,13] , there are some controversial issues concerning the contribution of nutrition teams to patient care and outcomes [11] . The analysis of this subject is beyond the scope of the present study, but it should be remembered that good clinical care combines the expertise of many disciplines [14,15] .…”

Section: Discussionmentioning

confidence: 99%

Impact of a Basic Nutrition Course for Residents at a Faculty Hospital

Kırdak

Iscimen²,

Tanir³

et al. 2008

Ann Nutr Metab

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Background/Aims: To assess whether a basic nutrition course for residents at a faculty hospital improves their knowledge of nutrition and increases the number of consultation requests for nutrition by alerting participants to the high prevalence of undernutrition in hospitals. Methods: The residents from 34 departments of basic, internal and surgical sciences were recruited to take a 1-day course. Questionnaires, designed to assess knowledge of nutrition, were completed at the beginning and at the end of the course. The results of the questionnaires and the number of consultation demands for nutrition before and after the course were compared. Results: The results of 161 participants were evaluated. The mean (±SE) numbers of correct answers given to the first and second questionnaires were 14.9 ± 0.22 and 18.7 ± 0.21, respectively (p < 0.01). When the number of requests for nutrition consultation during 7-month periods (just before and after the course) were compared, the mean number of requests in each month during these periods were found to be 1.81 ± 0.58 and 4.06 ± 1.20, respectively (p < 0.01). Conclusions: A short course of basic nutrition for residents improves their basic knowledge and leads to an increase in the number of consultation requests for nutritional support.

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“…Patients who achieved the therapeutic target were classified in the success group. In addition, patients whose nutrition status improved to a level at which they did not need [18][19][20][21][22]; these have revealed several positive findings about its efficacy; for example, it has had an impact on performing the appropriate nutrition assessment and therapy, improvement in patient's nutrition status, decrease in the complications caused by enteral nutrition or parenteral nutrition, shortening hospitalization periods, and saving medical expenses. However, factors associated with NST outcome have not been documented.…”

Section: Nst Outcomementioning

confidence: 99%

Exploration of Nutrition Support Team Outcome Predictors for Elderly

Hiramatsu¹

2017

J Nutri Med Diet Care

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Objective: To identify predictors associated with success of a Nutrition Support Team (NST) for the elderly. Research methods and procedures:A total of 101 patients who received NST intervention in 2015 were divided into two groups by NST outcome. Patients who achieved therapeutic targets were classified in the success group. Patients who discontinued treatment because of worsening condition or death were classified in the non success group. We assessed patient characteristics, laboratory data, and nutritional support methods. Prior to this study, we retrospectively extracted NST outcome predictors for patients treated in 2014, and identified cutoff values of quantitative variables using receiver operating characteristic analysis. The extracted predictors were as follows: % total energy expenditure (66.0%), albumin (2.4 g/ dL), total lymphocyte count (1,195/µL), C-reactive protein level (2.00 mg/dL), transthyretin level (8.5 mg/dL), Controlling Nutritional Status (CONUT) score (8), and the presence of Peripheral Parenteral Nutrition (PPN). We performed univariate and multivariate logistic regression analysis to identify the factors relevant to NST outcome. Results:We conducted the multivariate logistic regression analysis adjusted for age, sex, the presence/absence of PPN, and CONUT. A CONUT score ≥ 8 was an independent risk factor for NST outcome (Odds Ratio [OR]: 3.72, 95% Confidence Interval [CI]: 1.26-10.95). Moreover, the presence of PPN tended to be associated with NST outcome (OR: 2.63, 95% CI: 0.96-7.20). Conclusion:To increase the success rate of NST for elderly, it is important to identify the elderly at risk of non success NST outcome.

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Total Parenteral Nutrition Catheter Sepsis: Impact of the Team Approach

Cited by 155 publications

References 9 publications

Review article: the management of long‐term parenteral nutrition

Review article: the management of long‐term parenteral nutrition

Impact of a Basic Nutrition Course for Residents at a Faculty Hospital

Exploration of Nutrition Support Team Outcome Predictors for Elderly

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