Central venous catheterization for parenteral nutrition. Experience at Groote Schuur Hospital.

The aim of this study was to determine the incidence of complications of catheterization for total parenteral nutrition (TPN) in patients of the Parenteral Nutrition Unit of Groote Schuur Hospital. During the 2-year study period, 218 central venous catheters were inserted in 170 patients. The preferred technique of percutaneous infraclavicular subclavian venepuncture with subsequent subcutaneous tunnelling using a silicone elastomere catheter is described. The incidence of major complications of catheter insertion was 4,5% (pneumothorax 4, subclavian artery puncture 6). There was a 2,7% incidence of catheter malpositioning (requiring repositioning) at initial insertion. The mean duration of catheterization was 12,9 days. During this period there was a 6,9% incidence of mechanical complications (occluded lines 13, extravascular infusion 2). Catheter-related sepsis was suspected in 37 cases (16,9%) and all these catheters were removed, but in only 7 cases (3,2%) was the sepsis proved to be catheter-related. There was no correlation between the duration of catheterization and the development of catheter-related sepsis. Furthermore, there was no increase in the incidence of catheter sepsis in patients with sepsis before catheterization.

Home parenteral nutrition in a patient with Crohn's disease. A case report.

Total parenteral nutrition (TPN) carried out by the patient at home is a new concept in the treatment of intestinal failure. We describe a patient with Crohn's disease who has extensive involvement of the small intestine with resultant severe malabsorption, and who was therefore treated with 'home' TPN for 4 months. During this treatment there were no serious complications. The disabling symptoms present before hyperalimentation was commenced disappeared, and overall clinical improvement has been maintained for a further 6 months after TPN therapy. This case illustrates the feasibility of safe TPN at home in selected patients who have access to specialized hyperalimentation units.

Continuous positive pressure ventilation in children with bronchopneumonia.

The application of a small end-expiratory pressure of 5 cmH2O to the assisted ventilation of nineteen children (mean age 19 months) with bronchopneumonia was compared with intermittent positive pressure ventilation. Within 1 h of introducing continuous positive pressure ventilation the alveolar-to-arterial oxygen gradient was reduced in most patients, with an increase in functional residual capacity and a decrease in total pulmonary blood shunt. Physiological dead space was also reduced, a feature not observed in other studies, and the significance of this finding is discussed. The use of continuous positive pressure ventilation in broncho-pulmonary infection was shown to be effective even at small pressures, and can be recommended especially for patients requiring long-term ventilation.