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Preparing the Malnourished Patient for Parenteral Nutrition (PN)
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Because there is much less dilution of the infusate with a smaller vessel, peripheral veins are more sensitive to the osmolarity of infused solutions. Therefore, peripheral parenteral nutrition should generally contain final concentrations of less than 10% dextrose and 5% amino acids, with a final osmolarity of less than 900 mOsm (Kuwahara, Asanami, and Kubo 1998). Don’t forget that additives such as KCl can have a significant impact on osmolarity.
Biliary Leak after Pancreatoduodenectomy for Duodenal Neuroendocrine Tumors
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Gayatri Balachandran, Sadiq S. Sikora
In all patients with bile leak, there is a need to obtain the help of a nurse wound manager as bile is damaging to the skin. The use of zinc-based barrier creams, as well as stoma bags to minimize contact of bile with the skin, should be pursued. Total/peripheral parenteral nutrition must be considered in patients in whom enteral nutrition cannot be sustained. Macro- and micro-nutrient, as well as electrolyte deficiencies, must be treated aggressively.
Intestinal Failure
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Mattias Soop, John R.T. Monson, Gordon Carlson
If the intended recipient is not critically ill and the anticipated period of nutritional support is likely to be less than 14 days (as in many cases of acute intestinal failure), then parenteral nutrition may be provided adequately and safely via a peripheral vein, using a fine bore cannula. This is an attractive option as it allows some specially formulated peripheral parenteral nutrition solutions to be administered for short periods without the need for central venous cannulation and the associated risks. Although the use of fine peripheral catheters may reduce the contact between the parenteral feeding solution and the delicate venous endothelium, the ability to provide effective parenteral nutrition via the peripheral venous route remains limited by the tendency for intravenous feeding solutions, which are usually very hypertonic and acidic because of their dextrose and amino acid content, to cause thrombophlebitis and, ultimately, painful venous thromboses.31 Tailored peripheral feeding solutions are available and tend to have a high lipid content and a limited amino acid content in order to reduce their osmolality and increase their pH, thereby reducing the likelihood of thrombophlebitis.32 Although they may be effective for short periods, particularly if combined with ultrafine catheters,33 the ability to deliver high volumes of feed (more than 3 L) or more than 1,800 kcal/day peripherally without phlebitis limits their usefulness.
Management of patients with septic shock due to Candida infection
Published in Hospital Practice, 2018
Matteo Bassetti, Antonio Vena, Alessandro Russo
Risk factors for fungal infections in critically ill patients have been described in several studies, but only some of them have analyzed those associated with septic shock [33]. In a retrospective cohort study, length of stay in ICUs until the onset of candidemia was the only specific risk factor [19]. Invasive procedures, such as urinary and central venous catheter (CVC), and both peripheral parenteral nutrition and total parenteral nutrition [34] have been found associated with IC. The risk of IC is particularly high in patients with cancer and long-term CVC (e.g. port-a-cath) receiving intravenous chemotherapy [35,36]; also peripherally inserted central catheters have been associated with risk of candidemia [37,38]. In addition, chronic renal failure, renal transplantation, and receipt of immunosuppressive treatment with glucocorticoids may promote Candida translocation. Finally, ICU patients show some peculiar risk factors, such as prolonged ICU stay, high APACHE II score, delayed administration of antifungal therapy, inadequate source control, and multifocal Candida colonization [19].
Infection control measures to prevent hospital transmission of candida
Published in Hospital Practice, 2018
Parenteral nutrition liquids provide a suitable environment for candida colonization. Thus, it is also an important risk factor for candidiasis [38]. In a study of 145 candidemia episodes in non-neutropenic and elderly patients, total and peripheral parenteral nutrition administration which is longer than 7 days was found to be the most important risk factor for candidiasis [39]. In another study evaluating risk factors for candidiasis in cancer patients, which is longer than 5 days of parenteral nutrition reported to increase the risk of candidiasis [40]. Changing the parenteral nutrition to enteral feeding as soon as possible in appropriate patients is important to decrease the risk of invasive candidiasis.