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ABSTRACT Objective Standardization and systematization of data to provide quick access to compatibility of leading injectable drugs used in hospitals for parenteral nutrition. Methods We selected 55 injectable drugs analyzed individually with two types of parenteral nutrition: 2-in-1 and 3-in-1. The following variables were considered: active ingredient, compatibility of drugs with the parenteral nutrition with or without lipids, and maximum drug concentration after dilution for the drugs compatible with parenteral nutrition. Drugs were classified as compatible, incompatible and untested. Results After analysis, relevant information to the product’s compatibility with parental nutrition was summarized in a table. Conclusion Systematization of compatibility data provided quick and easy access, and enabled standardizing pharmacists work.
RESUMO Objetivo Padronizar e sistematizar informações, proporcionando um acesso rápido à compatibilidade dos principais medicamentos injetáveis utilizados no âmbito hospitalar para a nutrição parenteral. Métodos Foram selecionados 55 medicamentos injetáveis, os quais foram analisados individualmente com dois tipos de nutrição parenteral: dois em um, e três em um. Foram consideradas as seguintes variáveis: princípio ativo, compatibilidade dos medicamentos com a nutrição parenteral com e sem lipídios, e respectiva concentração máxima do medicamento após diluição, para os medicamentos compatíveis com a nutrição parenteral. Os fármacos foram classificados como compatível, incompatíveis e não testado. Resultados Após a análise, as informações pertinentes à compatibilidade do medicamento com a nutrição parenteral foram sintetizadas uma tabela. Conclusão A sistematização das informações de compatibilidade proporcionou um acesso rápido e fácil, viabilizando e padronizando o trabalho do farmacêutico.
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Humans , Parenteral Nutrition , Drug Incompatibility , Drug Interactions , Pharmaceutical Preparations/administration & dosage , Clinical Protocols/standardsABSTRACT
Objective To investigate the clinical effect of different nutritional therapies on the immune function of patients with malignant obstructive jaundice after percutaneous transhepatic cholangiodrainage (PTCD).Methods A total of 50 patients with malignant obstructive jaundice who were admitted to our hospital from January 2009 to March 2013 were randomly divided into two groups according to the admis-sion order.The patients in group A (n=25 )received enteral nutritional support after PTCD,and those in group B (n=25 )received total parenteral nutritional support after PTCD.Intra-group and inter-group comparisons were made in terms of jaundice clearance,nutritional indices,and body’s immune function on preoperative day 1 and postoperative day 7;comparison between the two groups was made by t test. Results Among the 50 patients who underwent PTCD,39 (78%)had good drainage,while 1 1 (22%)did not reach the expectation,of which,5 (10%)were in group A and 6 (12%)in group B.In both groups,the nutritional indices on postoperative day 7 were significantly higher than those on preoperative day 1(P0.05).The immune function of patients in both groups was significantly improved following PTCD and nutrition-al support (P0.05).Although the same scheme of nutritional support was used,there were 1 1 patients who did not achieve the expected jaundice clearance after PTCD and had limited improvement in immune function compared with those who had complete jaundice clearance (all P<0.05).Conclusion Jaundice clearance is closely re-lated to PTCD in patients with malignant obstructive jaundice,but not markedly associated with the ways of nutritional support.
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Objective To investigate the effects of enteral nutrition (EN) on the gut barrier function in patients with severe acute pancreatitis (SAP) and explore its clinical significance.Methods A total of 40 SAP patients from December 2009 to December 2011 was collected in this study.The 40 cases were divided into total parenteral nutrition (TPN) group (20 cases) and EN group (20 cases).The APACHE Ⅱ score and serum expression of endotoxin and intestinal fatty acid binding protein (IFABP) were compared between two groups.The serum expression of endotoxin and IFABP was determined by enzyme-linked immunosorbent assay method.Results The APACHE Ⅱ score and serum expression of endotoxin and IFABP were significantly decreased in EN group and TPN group after treatment of 1,7,14,21 d (P ＜0.05).The APACHE Ⅱ score was lower in EN group than that in TPN group after treatment of 7,14,21 d [(7.03 ±1.86) scores vs.(8.12 ±2.11) scores,(5.32 ± 1.14) scores vs.(6.87 ± 1.35) scores,(3.49 ±0.83) scores vs.(5.15 ± 1.02) scores,P ＜ 0.05].The serum expression of endotoxin was lower in EN group than that in TPN group after treatment of 7,14,21 d [(48.18 ± 15.48) EU/L vs.(60.12 ± 18.16) EU/L,(33.46 ± 12.04) EU/L vs.(51.32 ± 14.66) EU/L,(22.15 ± 7.81) EU/L vs.(35.62 ± 12.53) EU/L,P ＜ 0.05].The serum expression of IFABP was lower in EN group than that in TPN group after treatment of 7,14,21 d [(18.47 ± 3.55) ng/L vs.(22.57 ± 4.14) ng/L,(10.32 ± 2.68) ng/L vs.(18.11 ± 3.62) ng/L,(6.39 ± 2.26)ng/L vs.(12.16 ±3.06) ng/L,P ＜0.05].The APACHE Ⅱ score was positively correlated with serum expression of endotoxin (r =0.612,P ＜ 0.05) and IFABP (r =0.634,P ＜ 0.05).The serum expression of endotoxin was positively correlated with IFABP (r =0.627,P ＜ 0.05).Conclusions EN treatment shows more effective effect on improving the gut barrier function in SAP patients than TPN treatment.And it is worthy to be popularized in the clinical application.
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Aim: To characterize publications about total parenteral nutrition by identifying the main complications presented by patients who underwent this therapy and describe the main nursing care for these patients. Method: An integrative literature review from 1995 to 2011; Databases: LILACS, SciELO and BDENF. Results: Final sample was composed of 19 articles. Discussion: The central venous catheter infection, liver disorders, lung disorders, thromboembolic events, extravasation during infusion of the solution and hematological disorders were the main complications presented by patients who received total parenteral nutrition. Nursing care were related to the control of central venous catheter infection, clinical management of patients with total parenteral nutrition and infusion control. Conclusion: The administration of total parenteral nutrition involves simple actions. The nurse must assume its role with the team, ensuring performance, instruction and training to promote effective service to patients. Descriptors: Nursing; Parenteral Nutrition, Total; Parenteral Nutrition.
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Humans , Male , Female , Nursing Care , Nursing , Parenteral Nutrition, Total , Catheterization, Central VenousABSTRACT
Objective To investigate the effects on the condition of nutrition and immunologic function of gastric cancer treated with the insertion of jejunal nutrient canal after total gastrectomy.Methods In this study 113 gastric cancer patients were randomly divided into enteral nutrition group (the group of the fine-needle/catheter jejunostomy during operation,FCJ group) and parenteral nutrition group (PN group) after total gastrectomy.Evacuating time and postoperative complications were observed and relative laboratory parameters were measured prior to surgery (preoperative) and on days 3 and 7 postoperatively.Results The evacuating time in enteral nutrition group was shorter than that in parenteral nutrition group significantly[(4.1±2.2) d vs.(5.1 ±2.0) d,t =2.156,P =0.037];Serum level of prealbumin[( 18 ± 7 ) mg/dl vs.( 14 ± 7 ) mg/dl,t =2.370,P =0.022]and transferring[(205 ±45 ) mg/dl vs.( 186 ± 39 ) mg/dl,t =3.665,P =0.001]in enteral nutrition group on postoperative day 7 was higher than that in parenteral nutrition group;Serum IgA[( 2.3 ± 1.0 ) g/L vs.( 1.9 + 0.7 ) g/L,t =2.178,P=0.034],lgM[(1.4 ±0.4) g/L vs.(1.0 ±0.4) g/L,t=2.124,P=0.039]and IgG[(9.5 ±1.9) g/L vs.(9.0 ± 2.3 ) g/L,t =2.189,P =0.033]were higher in enteral nutrition group than that in parenteral nutrition group;The incidence of postoperative alimentary dysfunction in enteral nutrition group was lower than that in parenteral nutrition group( 3％ vs.13％,x2 =3.962,P =0.048).Conclusions It is safe and convenient to use early postoperative enteral nutrition support by fine-needle/catheter jejunostomy (FCJ) in gastric cancer patients immediately after total gastrectomy.
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Objective To explore the effects of different ways of nutritional support on organ functional recovery and prognosis in the elderly with multiple organ dysfunction syndromes (MODS).Methods 85 patients with MODS were randomized into enteral nutrition(EN) group (n=43 cases)and total parenteral nutrition(TPN) as control group (n=42 cases).EN group received nutritional support by nasogastric feeding tube or percutaneous endoscopic gastrotomy (PEG)/ percutaneous endoscopic jejunostomy (PEJ),and TPN group got nutrition by central vein for at least 2 months of therapeutic course.Body mass index (BMI),hemoglobin (HB),functions of liver and kidney,electrolytes,blood glucose and lipid,serum albumin(ALB),transferring(TRF),prealbumin (PA),immunoglobulin(IgA,IgG,IgM),leukomonocyte (CD3+,CD4+,CD4+/CD8+) were compared between two groups before and after treatment.Results The levels of Hb,BMI,ALB,TRF and PA after treatment for 1 and 2 months significantly improved (t1EN =2.672,2.440,2.209,3.331,5.025,t1TpN=2.720,2.337,2.179,3.418,2.221 and tEN2nd maonh=2.279,3.021,2.337,3.005,5.779,tTPN2nd month=2.118,2.956,3.018,3.310,2.119,all P＜0.05) in two groups as compared with before treatment,and there was remarkable difference in the level of PA between EN group and TPN group(t=2.336,P＜0.05).Hyperlipemia at 1 and 2 months after treatment occurred in TPN group (t1TPN =3.609,t2TPN =3.114,P＜0.05).The levels of IgG (t1st month=2.664,t2nd month =2.983,P＜0.05) and IgA (t1st month =2.437,t2nd month =3.005,P＜0.05) were higher after treatment for 1 and 2 months than before treatment.The levels of CD3+,CD4+ and CD4+/CD8+ cells improved (t2nd month =2.399,3.478,2.579,3.995,P ＜ 0.05 ) and IgM (t2nd month =3.886,P＜0.05) increased after treatment for 2 months in EN group.In EN group,aspiration pneumonia appeared in 34 cases and the occurrence rate decreaed (x2 =51.12,P ＜ 0.05 ) after PEG/PEJ operation (only 5 cases).Reflux esophagitis reduced and alleviated 2 months after PEG/PEJ operation (x2=13.53,P＜ 0.05).ConclusionsTimely sufficient EN support may improve nutritional and immunological status in elderly patients with MODS.PEG/PEJ can reduce the occurrence of aspiration pneumonia and reflux esophagitis caused by the nasogastric feeding tube.
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Objective To evaluate the effect of enteral nutrition (EN) versus total parenteral nutrition(TPN) on gut barrier function in patients with severe acute pancreatitis (SAP). Methods Sixtythree patients with SAP enrolled from 4 hospitals were randomly assigned into EN group(29 cases) and TPN group(34 cases). EN group patients were fed via a spiral nasojejunal feeding tube placed routinely by endoscopy or fluoroscopy, and TPN group patients were nourished intravenously with TPN during the same period. The changes of serum endotoxin, diamine oxidase, and urinary excretion of lactulose and mannitol ratio (L/M) were observed. Results Plasma concentration of endotoxin were markedly decreased in EN group as compared with that in TPN group at the 7th,14th ,21th day of entry trial [(39. 30 ± 15. 82) EU/L vs (73.05 ±21.16) EU/L,(22.64 ±14.31) EU/L vs (49.34 ±24.54) EU/L,(14.81 ± 10.93)EU/L vs ( 30. 08 ± 14. 10 ) EU/L, P ＜ 0. 05]. Plasma concentration of diamine oxidase were markedly decreased in EN group as compared with that in TPN group at the 7th, 14th day of entry trial [(9. 97 ± 3. 84)U/Lvs (19.89±9.89)U/L,(5.42±1. 84) U/Lvs (8.79 ±4.08) U/L, both P ＜ 0. 05]. The urinary L/M decreased significantly in EN group than those in TPN group at the 7th, 14th,21th day of entry trial (0.28 ±0.25 vs 0. 65 ±0.45,0.21 ±0. 18 vs 0.54 ±0.41,0.08 ±0.04 vs 0.29 ±0.06, all P＜0.05).Conclusion EN has better effect on improving intestinal barrier function than TPN in treatment of patients with SAP.
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Objective To investigate the influence of different nutritional support ways on intestinal dysbacteriosis in patients with severe acute pancreatitis (SAP).Methods Sixty-six patients with SAP from January 2003 to June 2010 were divided into study group and control group according to random digits table,33 cases in each group,they were treated with enteral nutrition and total parenteral alimentation support treatment respectively and the incidence of intestinal dysbacteriosis was observed and compared.Results In 7 - 10 d after the onset of SAP,the number of escherichia coli and enterococci in study group were significantly lower than those in control group,the difference was statistically significant (P ＜ 0.05 );the number of bifidobacterium and lactobacillus were significantly higher than those in control group (P ＜ 0.05 ).A total of 25 patients in both groups occurred intestinal dysbacteriosis,the total incidence was 37.9%,the incidence in study group was 24.2% (8/33) and which was significantly lower than that in control group [51.5%( 17/33 )](P ＜ 0.05 ).Conclusion Enteral nutrition support treatment can reduce the incidence of intestinal dysbacteriosis in patients with SAP,its efficacy is better than parenteral nutrition.
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Nutritional therapy with total parenteral nutrition (TPN) is usually performed in the critically ill patients who cannot ingest or digest food through the gastrointestinal tract. The process of well managed nutritional support by TPN is not simple, nor easy. Doctors experience various complications, the patients also suffer from much discomfort. Especially the younger patients, they are labile to more complications. The physicians should know thoroughly how to avoid the complications, how to effectively supply TPN solution to the patients. The author reviews the numerous complications during TPN and the methods for the prevention of complications.
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Humans , Critical Illness , Gastrointestinal Tract , Nutritional and Metabolic Diseases , Nutritional Support , Parenteral Nutrition, TotalABSTRACT
Objective To evaluate the efficacy and safety of oral erythromycin in the prevention and treatment of feeding intolerance in preterm infants. Methods The Cochrane Library,PubMed,EMBASE,CBMdise,VIP,WartFang and CNKl were searched up to the year of 2008.Randomized controlled trials (RCT) of erythmmycin for feeding intolerance in preterm infants were included.According to the dosage (low-dose,3-15 mg/kg and high dose,>15 mg/kg)and gestational age(≤32 weeks vs>32 weeks),all infants were divided into several subgroups.Meta-analysis was performed with the Cochrane Collaboration's software RevMan. Results Nine RCrs involving 542 premature infants were included.(1)In preventive studies,low-dose erythromycin could significantly decrease the duration of total parenteral nutrition compared with the high-dose erythmmycin (WMD=-2.99,95%CI:-3.99--1.98).(2)Intreatment studies,highdose erythromycin could significantly decrease the duration of total parenteral nutrition (WMD=-7.06.95%CI:-7.91--6.20,P<0.01)and hospital stay (WMD=-8.10,95%CI:-14.02--2.18,P=0.007)compared with the placebo when gestational age≤32 weeks. Erythromydn could decrease the incidence of iaundice(RR=0.36,95%CI:0.21-0.63,P=0.0003)which might be the effect of bigh-dose erytromycin. Conclusions Compared with placebo,oral erythromycin of different dosage might help to achieve full enteral feeding,shorten the duration of parenteral nutrition and hospital stay,and reduce the associated cholestasis jaundice of preterm infants with different gestational age respectively.
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OBJETIVO: Avaliar a freqüência de infecção relacionada ao cateter venoso central em pacientes submetidos a terapia nutricional parenteral. MÉTODOS: Foram analisados os cateteres venosos centrais de pacientes em terapia nutricional parenteral que tiveram a indicação de retirada do cateter venoso central por infecção, alta hospitalar, ou trombose. Os pacientes com infecção foram denominados de Grupo 1 e os demais de Grupo 2. RESULTADOS: Não houve diferença estatisticamente significante quanto ao estado nutricional dos 18 pacientes analisados. Foram analisados 28 cateteres e destes 68 por cento estavam infectados, sendo 72 por cento do Grupo 1 e 28 por cento do Grupo 2 (assintomáticos). No Grupo 1, houve infecção sistêmica em 70 por cento dos casos, já no Grupo 2 a hemocultura foi positiva em 17 por cento dos casos. A colonização por Staphylococcus sp. ocorreu em 48 por cento dos casos, seguida de Candida sp. (21 por cento), Enterococcus faecalis (16 por cento), Pseudomonas aerurginosa (10 por cento) e Proteus sp.(5 por cento). CONCLUSÃO: A contaminação de cateter venoso central utilizado para terapia nutricional parenteral é freqüente. Mesmo pacientes assintomáticos recebendo nutrição parenteral têm uma incidência maior de infecção por Candida sp. Portanto é necessária a criação de barreiras que impeçam a colonização destes cateteres venosos centrais, a fim de diminuir a morbimortalidade de pacientes dependentes deste tipo de terapia.
OBJECTIVE: The aim of this study was to evaluate the frequency of central venous catheter-related infections in hospitalized patients receiving total parenteral nutrition. METHODS: Central venous catheters were analyzed immediately after removal due to infection, hospital discharge or thrombosis. The patients with catheter-related infection were named Group 1 and the other patients were named Group 2. RESULTS: Eighteen patients were studied. There was no statistically significant difference in nutritional status between the two groups. A total of 28 catheters were analyzed. Sixty-eight percent of the catheters were infected: 72 percent of them were from Group 1 and 28 percent from Group 2 (asymptomatic patients). Systemic infection was diagnosed in 70 percent of the patients from Group 1. Positive blood culture was found in 17 percent of the patients from Group 2. The microorganisms found were: Staphylococcus sp. (48 percent), Candida sp. (21 percent), Enterococcus faecalis (16 percent), Pseudomonas aerurginosa (10 percent) and Proteus sp. (5 percent). CONCLUSION: Central venous catheter infection is common in hospitalized asymptomatic patients. Patients receiving total parenteral nutrition are most frequently infected with Candida sp. Therefore, the creation of barriers that block colonization in the central venous catheter is essential to decrease the morbidity and mortality among patients that depend on total parenteral nutrition.
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Humans , Male , Female , Infections/epidemiology , Parenteral Nutrition/adverse effectsABSTRACT
Objective To evaluate the clinical value of endoscopically nasojejunal feeding tube placement (ENFTP) for nutritional support in patients with severe acute pancreatitis (SAP). Methods Those SAP patients who treated with ENFTP (n= 47) or with total parenteral nutrition (TPN) (n=50) were retrospectively analyzed for laboratory parameters before and 1,2 and 4 weeks after nutrition support. Outcomes in the two groups were compared with respect to complications,mortality, duration of feeding, feeding costs,mechanical ventilation time and length of ICU or hospital stay. Results Four weeks after nutrition sypport, the hemoglobin and albumin were increased in ENFTP group as compared to TPN groups (P < 0. 05), while the blood sugar was decreased significant in ENFTP group than in TPN group (P<0.05). The incidence of peripancreatic or biliary infection and catheter-related infection were lower in ENFTP group than in TPN group. Duration of feeding and hospital stay were shorter, and nutrition cost was lower in ENFTP group (P<0.05). In addition, the APACHE Ⅱ score was significantly improved in ENFTP group(P<0.05). Conclusion ENFTP seems to be safe and less expensive in treatment of patients with acute pancreatitis.
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Objective:To investigate the proper method for treating traumatic chyloperitoneum. Methods: A retrospective analysis was performed on clinical data of 4 cases of traumatic chyloperi- toneum admitted to our hospital in recent 26 years. Results: All 4 cases were cured after conserva- tive treatment. Conclusion: Perdominantly integrated therapy including absolute diet,total parrenter- al nutrition(TPN) and abdominal cavity drainage can be the effective method for the treatment of trau- matic chyloperitoneum.
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Objectives To study the liver protective effect of L arginine for postoperative cirrhotic patients with primary liver cancer (PLC) receiving total parenteral nutrition (TPN). Methods Thirty preoperative cases were divided into two groups:Group A,TPN only( n =14);Group B,TPN+arginine( n =16). Liver function, serum lipid, immune function and serum nitric oxide were observed on preoperative phase, postoperative day 1 (POD 1) and day 7 (POD7) respectively. Liver biopsy was taken for histological study intraoperatively and on POD 7. Results Compared with group A on POD7,AST and TBIL level were near preoperative level, ALB level signiflcanly decreased, TG was lower than preoperative level, CD4 + and NO increased signiflcanly,and the degree of liver steatosis showed a signiflcant decrease in group B. Conclusions Supplement of appropriate amounts of L arginine increases hepatic NO level, reduces serverity of hepatic steatosis associated with TPN, promotes postoperative recovery of transaminase activity, ameliorates cell mediated immunity and anti infection capacity in postoperative PLC patients.
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Objective [WT5”BZ] To evaluate the effects of glycyl glutamine (Gly Gln) on the small intestinal graft. [WT5”HZ]Methods [WT5”BZ] Ten outbrid pigs undergoing small bowel autotransplantation were randomly divided into 2 groups. In STPN group, the animals received standard TPN devoid of Gly Gln,and in GTPN group,the animals received isonitrogenous (0 3?g?kg -1 ?d -1 )and isocaloric (nonprotein calory:137 9?kJ?kg -1 ?d -1 ) TPN with 2% Gly Gln.Animals were fed for 28 days. [WT5”HZ]Results [WT5”BZ] At the end of TPN,the mucosal contents of Gln (1 14?0 20)??mol/g tissue wet weight, protein (101?22)?mg/g and the villous contents of DNA (3 84?0 39) and RNA (3 31?0 14),the graft villous height (308?52) ?m, surface area (0 154?0 019) mm 2 and mucosal thickness(665?72) ?m were significantly higher in the GTPN group than that in STPN group ( P
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Objectives To investigate the effect of nitric oxide(NO) on hepatic steatosis caused by total parenteral nutrition(TPN) in ratsMethods Thirty Wistar rats were randomly divided into five groups: Group A, normal control; Group B, TPN group;Group C, TPN plus L arginine; Group D, TPN plus N G nitrio L arginine methyl ester(L NAME,NOS inhibitor); Group E, TPN plus L arginine and L NAME. At the seventh day, liver function tests were performed and the livers were resected to test the lipid and nitric oxide content, and nitric oxide synthase activity.[WT5”HZ] Results [WT5”BZ] The hepatic lipid content 〔triglycerid(?mol/g), cholesterol(?mol/g)〕in group B significantly increased compared with group A (39 3?2 4、13 1?1 1 vs. 6 9?0 8、5 6?0 6)( P
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Objective To study the effect of epidermal growth factor(EGF) on the morphology and absorption of small bowel graft. Method Total small bowel transplantion was performed between inbred Wistar(RT1 k) rats. Total parenteral nutrition(TPN group,n=10) and EGF supplemented TPN(EGF group,n=10) was used from POD2 to POD10. ResultsMucosal villous height,crypt depth, mucosal thickness and villous surface area were found significantly larger in EGF group than in TPN group.Normal ultrastructure of the graft was maintained in EGF group, Atrophied microvilli and broken mitochondrial crista were observed in TPN group. Plasma 15N-Glycine level was higher in EGF group than in TPN group. Conclusion EGF improves mucosal morphology,preserves enterocyte ultrastructure, enhances amino acid absorption.
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Lipid emulsion, glucose, amino acids, electrolytes, vitamins and trace ele- ments were mixed in a definite order to prepare 10 different total nutrient admixture solutions. The pH and osmolality of these solutions did not change significantly during 14 days of storage at 4℃.Mean diameters of the lipid particles on different occasions for the different solutions varied from 0.3135?0.1012?m to 0.4813?0.1893 ?m. 94.93% of particles were less than 0.6 ?m, and none greater than 6?m. Cultures were all negative.74 patients received 1,796 such infusions. No adverse clinical reactions or abnormal laboratory parameters were observed. Patients on treatment for more than one week showed improved nitrogen balances. Serum transferrin and albumin were increased to varying levels when treatment was for more than two weeks.