ABSTRACT
BACKGROUND: Home Parenteral Nutrition is a therapeutic option to improve quality of life in chronic intestinal failure. AIMS: To describe frequency of complications both in cancer and noncancer patients. METHODS: This study was performed on 270 adult patients (52% with cancer, 48% without cancer) followed for a total of 371 years of treatment. Mean duration of therapy was 191±181 for cancer and 830±1168 days/patient for noncancer. The treatment was administered by a competent, dedicated provider. Patients received our prescribed "all-in-one admixtures" at their homes. RESULTS: Catheter-related complications/1000-days-catheter was 1.40; mechanical complications were comparable in cancer (0.82) and noncancer (0.91) patients while a statistically significant difference was observed between cancer (0.71) and noncancer (0.46) patients for sepsis. Bacterial infections were more frequent in noncancer, mycotic infections primarily affected cancer patients. In our experience 49% of the patients were readmitted, with a low incidence rate of 0.89/1000 days-catheter. The incidence of hepatobiliary complications in our population was 65%. The degree of liver damage was related to short bowel syndrome and to length of treatment. CONCLUSIONS: This study indicated that cancer patients are more vulnerable to CVC-related infections during Home Parenteral Nutrition and that a safer Home Parenteral Nutrition protocol should be adopted in order to contain CVC-related complications.
Subject(s)
Anorexia/therapy , Catheter-Related Infections/microbiology , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Central Venous Catheters/adverse effects , Parenteral Nutrition, Home/adverse effects , Short Bowel Syndrome/therapy , Adult , Anorexia/diagnosis , Anorexia/epidemiology , Catheter-Related Infections/diagnosis , Catheter-Related Infections/epidemiology , Catheter-Related Infections/therapy , Catheterization, Central Venous/instrumentation , Chronic Disease , Female , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Neoplasms/epidemiology , Parenteral Nutrition, Home/instrumentation , Patient Readmission , Risk Factors , Short Bowel Syndrome/diagnosis , Short Bowel Syndrome/epidemiology , Time Factors , Treatment OutcomeABSTRACT
Parenteral nutrition is a life-saving treatment for patients who have acute and chronic intestinal failure. Severe cholestasis induced by total parental nutrition (TPN-IC) is characterized by bile duct regeneration, portal inflammation, and fibrosis. Its progression could be very rapid, and in some patients liver cirrhosis may develop in few months. This article describes the definition, incidence, hepatic changes, histopathologic findings, risk factors, pathogenesis, and clinical implications of TPN-IC. The goal is to improve hospital and home management, quality of life, and prognosis of patients requiring parenteral nutrition.
