What is it?
Parenteral nutrition can feed a complete, virtually every hospitalized patient with a non-functioning digestive tract, providing all the nutrients directly into the circulatory system. Nutrients reach the venous circulation directly, without passing through the intestinal barrier, differently to what happens under physiological conditions.
What are the signs for restrict the use of parenteral nutrition?
You can restrict the use of parenteral nutrition to patients with diseases that cause a failure of gastrointestinal function, presenting resistance to all other types of treatment or are not candidates for other therapeutic alternatives at the time.
The most common are:
- Short bowel syndrome: in the event that retained less than 60 cm of intestine can be susceptible of parenteral nutrition indefinitely. In other cases it may serve for a period of adaptation to the new state (if bowel resection) and be a complement to an insufficient oral intake.
- Crohn’s disease: a small percentage of patients affected by this disease can not maintain an adequate nutritional support by mouth or with a defined enteral formula. In addition, some cases may suffer bowel resections. In these situations you get to use parenteral nutrition bringing the number of hospital admissions decreased, although the disease run its course and not prevent the development of fistulas or any other complication while receiving parenteral nutrition.
- Chronic radiation enteritis: in the treatment of tumors with radiation to the pelvis or abdomen can be caused damage to the gastrointestinal tract, including malabsorption, chronic obstruction, bleeding, fistulas, steatorrhea … The parenteral nutrition may be useful in the management of these situations.
- Motility disorders: motility diseases, both congenital and acquired, that may present with intestinal pseudo-obstruction.
- Enterocutaneous fistulas: parenteral nutrition can help to achieve spontaneous closure of these fistulas, resulting from surgical complications or trauma. You can also help the metabolic and nutritional stabilization of the patient before surgery.
- Tumor disease: can be useful in the case of tumors of small and large intestine, abdominal tumors and genitourinary. It can also be used in patients with potentially curable tumor disease requiring aggressive treatments that can cause temporary gastrointestinal dysfunction them.
- AIDS: be candidates those AIDS patients who develop severe diarrhea, intestinal disease or who are incapable of oral intake. In these cases the use of aseptic technique will be very important to prevent complications of catheter infection is very important.
What formulas exist?
To select and prepare the appropriate formula it is, first, to measure energy expenditure patient. This data is used as the basis for calculating the calorie intake required. This calculation depends if we are to get a maintenance or if it is to achieve a weight gain (if malnourished patients).
Mixtures of “one” in which the same nutrition bag, 3 liters, fats, carbohydrates and proteins are added, together with minerals and vitamins are used.
The use of this system can be administered both in hospitals and at home.
How is it given?
Normally be nourishments protracted so we will have to establish a venous access long-term, you can access a vein of high flow, usually the vena cava to prevent the production of phlebitis, pain and vein thrombosis, caused by the high osmolarity of the formula.
Venous access should be comfortable and not restrict or interfere with normal mobility and activity, even with exercise. It should be available to the patient, being seen without difficulty, so you can perform infusion processes and maintenance.
Venous access systems most used are:
- External tunneled catheters.
- Portacath or implanted subcutaneous reservoir.
Currently night infusion system is preferred in about 12 hours. Most of the infusion will take place during sleep and the patient will be free 12 hours a day to return to work and lead a lifestyle as close to normal.
Volumetric infusion pump with security systems that enable secure and efficient administration during sleep is recommended.
What the patient should know?
Among the things you should know the patient in relation to parenteral nutrition it is:
- Instruct on aseptic technique catheter care.
- Emergency procedures including management in case of damage or breakage of the catheter.
- Training in techniques clamping and occlusion.
- Knowledge Infusion Pump.
- Knowledge for monitoring changes in fluids. You must train the patient in making data such as weight, fluid inputs and outputs, temperature, glucose urine…
You need to track by the team that serves you, the patient should be trained to detect any excessive weight change, swings … diuresis, which may lead idea of some kind of anomaly.At first it will be necessary to conduct a biochemical control biweekly during the first month with controls glucose, urea, creatinine, liver function tests, triglycerides, plasma proteins, levels of electrolytes, minerals and CBC. Later you can go dilating the controls and there are cases that are held every three or even six months in stable patients.