Parenteral nutrition comparative studies

In a study of catheter infection in patients treated with total parenteral nutrition a distant septic focus was present in 165 of 244 patients (188 of 269 catheters 70%). There was a colonization rate of 19% of the catheters of the patients with a distant septic focus, compared with 7.4% in patients without a distant septic focus. There was a high mortahty rate in patients with a distant septic focus and a colonized catheter sepsis was responsible for 33 of the 48 deaths (69%) in this group (33). 

Beau P, Matrat S. A comparative study of polyurethane and silicone cuffed-catheters in long-term home total parenteral nutrition patients. Clin Nutr 1999 18(3) 175-7. 

Infusion phlebitis presents a problem in parenteral nutrition. Various alternative techniques of administration have been compared in order to identify means of countering this problem (9). Mechanical trauma appears to be a causative factor it can be reduced by hmiting the time of exposure of the vein wall to nutrient infusion and by minimizing the amount of prosthetic material within the vein (10). This is hkely to be even more important in small veins. In one study the addition of heparin (500 U/1) and hydrocortisone (5 micrograms/ml) significantly reduced the risk of thrombophlebitis from 0.43 to 0.11... 

Kerin MJ, Pickford IR, Jaeger H, Couse NF, et al. A prospective and randomised study comparing the incidence of infusion phlebitis during continuous and cyclic peripheral parenteral nutrition. Chn Nutr 1991 10 315. 

Abou-Assi S, Craig K, O Keefe SJD, et al. Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis Results of a randomized comparative study. Am J Gastroenterol 2002 97 2255-2262. Scolapio J, Malhi-Chowla N, Ukleja A. Nutrition supplementation in patients with acute and chronic pancreatitis. Gastroenterol Clin North Am 1999 28 695-707. 

Comparative studies In a systematic review of five randomized controlled comparisons of parenteral and enteral nutrition in patients with acute pancreatitis, there was diarrhea in 6 of 92 patients (7%) versus 24 of 82 (29%) respectively and hyperglycemia in 21 of 92 patients (23%) versus 7 of 82 (11%) [18 ]. The added risk of infections... 

Comparative studies In a randomized, double-blind study in 28 children who were receiving parenteral nutrition, an intravenous lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil was compared with soybean oil... 

A fish oil-based intravenous lipid emulsion in the treatment of liver disease associated with parenteral nutrition has been compared with soybean oil in an open study in 42 infants with short bowel syndrome who developed cholestasis [35 ]. There were three deaths and one liver transplantation in those who received the fish oil, compared with 12 deaths and 6 transplants in those who received soybean oil The fish oil was not associated with hypertriglyceridemia, coagulopathy, or deficiency of essential fatty acids. 

Similarly, for intractable diarrhea in infants, there are no randomized controlled studies comparing TPN to starvation. However, two small experiences have been reported with 100% survival in an illness which historically has a 40% mortality rate (Hyman et al, 1971 Keating and Ternberg, 1971). The results of these and similar studies have made parenteral nutritional support an integral part of the therapy of this condition. 

The indications for the use of vena cava catheters are measurement of central venous pressure, infusions and transfusions in critical circulatory conditions, long term infusions, parenteral nutrition and administration of hypertonic solutions. While the use of caval catheters may save many lives, it is not without risks. In a one year prospective study performed in nine hospitals in Germany, Austria and Switzerland- we evaluated our experience with 3241 central venous catheterizations and compared the results with other reported series (11,000 cases). 

Biliary tract In a study of 66 infants with cholestasis associated with parenteral nutrition, there were 10 deaths and one referral for liver transplant in the first year of life, all of whom had at least one positive blood culture after the onset of cholestasis [70 ]. Maximum conjugated bilirubin in these 11 infants was 270 pmol/l, compared with 145 pmol/l in babies who recovered. A maximum conjugated bilirubin concentration over 170 pmol/l was a susceptibility factor for death or transplantation. 

Observational studies The effect of peripherally inserted and non-peripherally inserted catheters on infection rates in adults requiring home parenteral nutrition (PN) has been examined in a retrospective study of 101 patients. Seventy-five percent of infections developed within the first 6 months of hospital discharge, and most of these were attributed to gram positive organisms. Patients with peripherally inserted catheters had a significantly higher rates of infections compared with non-peripherally inserted catheters (P=0.018) [lOl ]. A four-year review of 145 cases of peripherally inserted central catheters for long-term PN in infants with intestinal failure showed that the overall... 

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