Impact of a nutritional support service on VA surgical patients.

The impact of a multidisciplinary Nutritional Support Service (NSS) on the reduction of complication was evaluated in 78 consecutive patients who received total parenteral nutrition (TPN) on the same VA surgical service. Patients were placed into one of three groups (pre-NSS, transition-NSS, post-NSS) based on the evolution of the NSS. A significant reduction in catheter sepsis was observed and was attributable to the establishment of an NSS, specifically, a nurse specialist and protocols for catheter insertion and care.

Experience with a new gastrostomy-jejunal feeding tube.

Many patients in need of long-term feeding by tube enterostomy have neurologic or mechanical deficits that increase their risk for aspiration. To reduce this risk, a combined gastrostomy-jejunal tube has been developed. This tube permits gastric decompression while the formula is being delivered into the jejunum. The use of this tube has been evaluated in 45 patients. There were three (7%) major complications and two (4%) postoperative deaths. The deaths did not appear to be directly related to the insertion of the tube. There was no clinical evidence of aspiration. This tube can be used to deliver postoperative and long-term enteral nutrition with minimal rates of morbidity and mortality.

The critically ill patient: nutritional implications.

The nutritional needs of critically ill patients are increased by the metabolic demands generated from injury and sepsis. Parenteral nutrition may be necessary initially to meet their nutritional requirements, with transition to enteral nutrition when their nutritional requirements can be met via the gastrointestinal tract. Meeting the nutritional needs of patients enhances their ability to tolerate the medical and surgical interventions necessary to promote resolution of their illness.