RESUMO
UNLABELLED: In adult home parenteral nutrition (HPN) programme patients up to now no evidence-based recommendations exist on the central venous catheter maintenance nor venous thrombosis prevention. The use of heparin flushes could be linked with long term complications, besides, anticoagulants use is controversial. OBJECTIVES: To be aware of the usual maintenance practice for HPN central venous catheters, catheter occlusion and related venous thrombosis incidence in our country. METHODS: Retrospective study of active HPN patients older than 18 years registered by the NADYA- SENPE working group until November 2008. RESULTS: 49 patients were registered (16 males and 33 females), with an average age of 52.1 ± 13.9 years, belonging to 6 hospitals. HPN length was 57.4 ± 73.3 months with 5.8 ± 1.8 PN days a week. The most frequent pathologies were actinic enteritis, intestinal motility disorders and mesenteric ischemia (20.4% each), and neoplasm (16.3%). The reason for HPN provision was short bowel syndrome (49.0%), and intestinal obstruction (28.6%). Neoplasm (16.3%), thrombotic diathesis, thromboembolic syndrome and bed rest (6.1% each) were the main venous thrombosis adjuvant factors. Tunnelled catheters were used in 77.6% of patients, with implanted port-catheters in the remainder. Maintenance of the line was done with saline solution flushes (28.6%) and different concentrations of heparin solutions (69.4%). When heparin was used, it was removed before PN infusion in 63.3% of patients. Catheter occlusion and venous thrombotic events rates were 0.061/10³ and 0.115/10³ HPN days respectively. Eleven patients (22.4%) were treated with anticoagulant drugs due to previous episodes of venous thrombosis or pulmonary embolism. CONCLUSION: [corrected] The incidence of catheter related thrombotic complications incidence is low in this group of patients on HPN. There is a great variety of practices focused on the prevention of both: line occlusion and catheter related venous thrombosis. In conclusion, it would be necessary to standardize practice.
Assuntos
Catéteres/efeitos adversos , Falha de Equipamento , Nutrição Parenteral no Domicílio/efeitos adversos , Trombose Venosa/prevenção & controle , Adulto , Idoso , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Cateterismo Venoso Central , Feminino , Heparina/efeitos adversos , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral no Domicílio/instrumentação , Nutrição Parenteral no Domicílio/estatística & dados numéricos , Sistema de Registros , Estudos Retrospectivos , Espanha/epidemiologia , Trombose Venosa/etiologiaRESUMO
OBJECTIVE: To communicate the results from the registry of Home-Based Enteral Nutrition of the NADYASENPE group in 2007. MATERIAL AND METHODS: We included every patient in the registry with home enteral nutrition any time from January 1st to December 31st of 2007. RESULTS: The number of patients with home enteral nutrition in 2007 was 5,107 (52% male) from 28 different hospitals. 95.4% of them were 15 yr or older, with a mean age of 67.96 +/- 18.12, and 4.2 +/- 3.38 among patients aged 14 yr or less. The most common underlying diseases were neurological (37.8%) and neoplastic diseases (29.3%). Enteral nutrition was administered p.o. in most patients (63.5%), followed by nasogastric tube (25.9%), while gastrostomy was only used in 9.2%. The mean time in enteral nutrition support was 9.4 months and the most common reasons for withdrawal were death (58.7%) and switching to oral intake (32%). Activity was limited in 31.4% of patients and 36.01% were house-bound. Most patients needed partial (26.51%) or total (37.68%) care assistance. Enteral formula was provided by hospitals to 69.14% of patients and by pharmacies to 30.17% of them, while disposable material was provided by hospitals to 81.63% and by Primary Care to the remaining patients. CONCLUSIONS: In 2007, there has been an increase of more than 30% of patients registered with home enteral nutrition comparing with 2006, without any big difference in other data, but a higher proportion of patients with enteral nutrition p.o.
Assuntos
Nutrição Enteral , Assistência Domiciliar , Sistema de Registros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Nutrição Enteral/métodos , Nutrição Enteral/estatística & dados numéricos , Nutrição Enteral/tendências , Feminino , Gastrostomia/estatística & dados numéricos , Assistência Domiciliar/estatística & dados numéricos , Humanos , Lactente , Intubação Gastrointestinal/estatística & dados numéricos , Jejunostomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Doenças do Sistema Nervoso/terapia , Espanha , Adulto JovemRESUMO
OBJECTIVE: To communicate the results obtained from the registry of Home-Based Enteral Nutrition (HBEN) of the NADYA-SENPE group for the year 2006. MATERIAL AND METHODS: Recompilation of the data from the HBEN registry of the NADYA-SENPE group from January 1st to December 31st of 2006. RESULTS: During the year 2006, 3,921 patients (51% men) from 27 hospital centers were registered. Ninety-seven percent were older than 14 years. The mean age for those < 14 years was 4.9 +/- 3.9 (m +/- SD) and in those > or = 14 years, it was 68.5 +/- 18.2 years. The most common underlying disease was neurological pathology (42%), followed by cancer (28%). Enteral nutrition was administered p.o. in 44% of the patients, through nasogastric tube in 40%, gastrostomy in 14%, and jejunostomy in 1%. The average time of nutritional support was 8.8 months. The most common reasons for ending the therapy were patient's death (54%) and switching to oral feeding (32%). Thirty-one percent of the patients presented a limited activity and 40% were confined to bed/coach. Most of the patients required partial (25%) or total (43%) care assistance. The nutritional formula was provided by the hospital in 62% of the cases and from the reference pharmacy in 27%. The fungible material was provided by the hospital in 80% of the cases and by primary care in the remaining patients. CONCLUSIONS: Although the number of registered patients is slightly higher than that from the last years, there are no important changes in the patients characteristics, or way of administration and duration of enteral nutrition.
Assuntos
Nutrição Enteral/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Sistema de Registros , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , EspanhaRESUMO
OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the year 2006. METHODOLOGY: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st to December 31st 2006. RESULTS: 103 patients with HPN were registered (47 males and 56 females), belonging to 19 hospitals. Average age for the 91 patients older than 14 years old was 53.3 +/- 14.9 years old, and that for the 12 patients under 14 years old was 2 +/- 0 years old. Most frequent pathology was neoplasm (29%), followed by intestinal motility disorders (13%). The reason for HPN provision was short bowel syndrome (40%), intestinal obstruction (22%), and malabsorption (21%). Tunneled catheters were mostly used (45%), followed by implanted port-catheters (32%). Catheter related infections were the most frequent complications, with a rate of 0.85 episodes / 10(3) days. HPD was provided for more than two years in 50% of the cases. By the end of 2006, 70.9% of the patients remained active; exitus was the most frequent reason to end HPN (53%). Complementary oral or enteral nutrition was provided to 52% of the patients. 48% of the patients had a normal activity level, and a 55% were autonomous. PN formula was supplied by the hospital in 82% of the cases, while this number was 78% for fungible materials. 27% of the patients were eligible for intestinal transplant. CONCLUSIONS: We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections with respect to the 2004-2005 period.
Assuntos
Nutrição Parenteral no Domicílio/estatística & dados numéricos , Sistema de Registros , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistemas On-Line , Nutrição Parenteral no Domicílio/efeitos adversos , Nutrição Parenteral no Domicílio/mortalidade , Espanha , Fatores de TempoRESUMO
INTRODUCCIÓN: la Nutrición Parenteral Total (NPT), el tratamiento inmunosupresor con Ciclosporina A (CsA) y la Enfermedad Inflamatoria Intestinal (EII) son factores conocidos de disfunción hepática. Su asociación, sin embargo, ha sido escasamente analizada. MÉTODOS: se estudian de forma retrospectiva las alteraciones en la bioquímica hepática (GOT, GPT, FAI, GGT y Bt) de pacientes ingresados, consecutivamente, en nuestro centro por brote grave de EII y analítica basal normal, desde Enero 1992 a Julio 1997: n = 50, 29 V/21 H, edad 32 a (16-78), 76 por ciento Colitis Ulcerosa (CU), 24 por ciento Enf. Crohn (EC), 28 por ciento formas de debut. Todos los pacientes recibieron 6metilprednisolona (MP) ev (0,75-1 mg/kg/d) y NPT, como tratamiento estándar. El 42 por ciento (21/50) requirió tratamiento adicional con CsA ev (5 mg/kg/d) al inicio o en el transcurso de la primera semana de NPT, durante 7 a 24 días, para el control de su enfermedad por falta de respuesta clínica. En base al tratamiento recibido se definieron dos grupos de estudio: Grupo I = MP + NPT (n = 29) y Grupo Il = MP + NPT + CsA (n = 21), -ambos homogéneos en todos los parámetros analizados-. Se realizaron controles analíticos semanales durante el periodo de tratamiento. RESULTADOS: el 62 por ciento de los pacientes (31/50) presentó alteración en la bioquímica hepática -definida previamente como alteración de 2 o más parámetros, 2 o más veces los valores de normalidad-. No se observaron diferencias estadísticamente significativas entre los grupos 1 y 11 (15/29 vs 16/21, p = NS). Las enzimas GGT y GPT fueron los parámetros que más se alteraron; la máxima elevación apareció en el transcurso de la 3ª semana de tratamiento y no superó en seis veces los valores de normalidad. Al suspender la NPT y el tratamiento inmunosupresor, dichas alteraciones desaparecieron. CONCLUSIONES: estos resultados nos permiten concluir que, en este grupo de pacientes, la asociación de NPT y CsA no provoca más disfunción hepática que la ocasionada por la NPT (AU)