Central parenteral nutrition

Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M (2009) ESPEN guidelines on parenteral nutrition central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 28(4) 365-377... 

Jakobowski, D., Ziegler, M., and Pereira, G., 1979, Complications of pediatric parenteral nutrition Central versus peripheral administration, J. Parent. Enter. Nutr. 3 29. 

TPN may be administered through a peripheral vein or through a central venous catheter. Peripheral TPN is used for patients requiring parenteral nutrition for relatively short periods of time (no more than 5-14 days) and when the central venous route is not possible or necessary. Peripheral TPN is used when the patient s caloric needs are minimal and can be partially met by normal... 

Patients who require parenteral nutrition for >7 d ° Must be administered through a central vein... 

Parenteral nutrition (PN) provides macro- and micronutrients by central or peripheral venous access to meet specific nutritional requirements of the patient, promote positive clinical outcomes, and improve quality of life. PN is also referred to as total parenteral nutrition or hyperalimentation. 

Solutions for PPN have lower final concentrations of amino acid (3% to 5%), dextrose (5% to 10%) and micronutrients as compared to central parenteral nutrition (CPN). 

Peripheral PN (PPN) is a relatively safe and simple method of nutritional support. PPN candidates do not have large nutritional requirements, are not fluid restricted, and are expected to begin enteral intake within lOto 14days. Thrombophlebitis is a common complication this risk is greater with solution osmolarities greater than 600 to 900 mOsm/L (Table 60-2). Solutions for PPN have lower final concentrations of amino acid (3% to 5%), dextrose (5% to 10%) and micronutrients as compared to central parenteral nutrition (CPN). 

The instrumentation for atomic absorption spectrophotometry is very well-defined and can range from a relatively simple manually operated instrument to a completely automated system that is on line to a central database. In addition, accurate results can be obtained on a wide range of samples. The future lies in using this technique to solve problems rather than to further develop instrumentation. For example, the FDA published new guidelines for the aluminum content of products used in total parenteral nutrition. 

Superior vena cava thrombosis has been described after frequent central venous catheterization and total parenteral nutrition, with eventual partial recovery (12). 

HIV-positive subjects are expected to be at even greater risk of line-related infection. A prospective study of 212 subjects with HIV infection with 327 central venous catheters has provided evidence of this enhanced risk (36). Over the period 1994-97, 33% were suspected as being infected, although only 61 episodes were diagnosed as catheter-related sepsis. Three variables affected the rate of sepsis parenteral nutrition, low numbers of circulating CD+ cells, and a high Apache score. 

Muckart DJ, Neijenhuis PA, Madiba TE. Superior vena caval thrombosis comphcating central venous catheterisation and total parenteral nutrition. S Afr J Surg 1998 36(2) 48-51. 

Colomb V, Fabeiro M, Dabbas M, Goulet O, Merckx J, Ricour C. Central venous catheter-related infections in children on long-term home parenteral nutrition incidence and risk factors. Clin Nutr 2000 19(5) 355-9. 

Infection has long been recognized as a risk of parenteral nutrition and it has proved impossible to eliminate it (SEDA-22, 379). Once established, sepsis can increase the risk of fat overload syndrome. In an extensive study in Taiwan there was sepsis with positive blood cultures in 56 of 378 children receiving parenteral nutrition the risk factors were longer duration of parenteral nutrition, age under 3 months, the use of central venous catheters, gastrointestinal disease as an indication for parenteral nutrition, low birth weight, and short gestational age in prematurity (128). 

Thrombosis can occur, especially (for unclear reasons) in patients suffering from AIDS. The incidence of symptomatic central venous thrombosis in patients with AIDS receiving home parenteral nutrition has been estimated at 0.009 per patient-month (80). However, in one... 

A filter should be used when infusing either central or peripheral parenteral nutrition admixtures. Data are not available to determine which size filter is most effective in trapping precipitates. 

Duerksen DR, Ahmad A, Doweiko J, Bistrian BR, Mascioli EA. Risk of symptomatic central venous thrombotic complications in AIDS patients receiving home parenteral nutrition. J Parenter Enteral Nutr 1996 20(4) 302-5. 

Jatoi A, Hanjosten K, Ross E, Mason JB. A prospective survey for central line skin-site colonization by the pathogen Malassezia furfur among hospitalized adults receiving total parenteral nutrition. J Parenter Enteral Nutr 1997 21(4) 230-2. 

Parenteral nutrition support therapy is used for disorders of the GI track, bums, and debilitating disease. Parenteral nutrition support therapy is administered through a central venous line (subclavian or internal jugular veins) to prevent irritation to the peripheral veins. 

Do not use the parenteral nutritional line to draw blood, give medication, or check central venous pressure. 

Records of enteric nutrition, peripheral parenteral nutrition, and central parenteral nutrition. 

Biotin Deficiency. Relative to many of the vitamins, it is easy to induce a biotin deficiency by feeding volunteers raw egg white. Avidin, a basic protein found in egg white, forms salt linkages with acidic biotin and prevent its transport across the intestinal barrier. Cooked egg white is not a problem. Because biotin is found in the yolk, eating whole raw egg will not induce a deficiency. Deficiencies also were caused in patients on total parenteral nutrition (TPN) because biotin was not included in the early formulations. Symptoms include dermatitis, loss of hair color, and central neurological effects. 

A decrease in PaC02 occurs when ventilatory excretion exceeds metabolic production. Because endogenous production of CO2 is relatively constant, negative CO2 balance is primarily caused by an increase in ventilatory excretion of CO2 (hyperventilation). The metabolic production of CO2, however, may be increased during periods of stress or with excess carbohydrate administration (e.g., parenteral nutrition). Hyperventilation may develop from an increase in neurochemical stimulation via either central or peripheral mechanisms, or be the result of voluntary or mechanical (iatrogenic) hyperventilation. 

Immunodeficiency diseases High-dose corticosteroids Immunosuppressants Antineoplastic agents Central venous catheters Total parenteral nutrition (TPN)... 

Parenteral nutrition (PN) solutions may be appropriately formulated for administration by peripheral or central venous access. 

CAA crystalline amino acid CEAA conditionally essential amino acid CPN central parenteral nutrition CSP compounded sterile preparations EFAD essential fatty acid deficiency... 

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