Freshwater, D.A.; Saadeddin, A.; Jones, B.J.M.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA40
Academic Journal
Background: Home Parenteral Nutrition (HPN) is accepted in the treatment of intestinal Failure but is mostly restricted to a few large specialist centres in the UK. Methods: Adult HPN patients at a single district general hospital (Dudley Group of Hospitals NHS Trust) were analysed by indications, complications and outcome. Results: 2310 patient weeks of HPN were provided to 23 patients, aged 18-80 years with intestinal failure (Crohn's disease 8, small bowel infarction 5, other Gl disease 3, radiation enteritis 2, colonic carcinoma 2, stricture 2, cancer small bowel 1, ulcerative colitis 1, pseudo-obstruction 1, gastric cancer 1, volvulus 1) N.B. some patients had more than one underlying diagnosis. 28% were subsequently able to discontinue HPN. 46% of patients died while on HPN but cause of death was not related to HPN. 82% had a Karnowsky Index of 60 (generally self-caring) or greater. HPN complications for 22 of the 23 patients were 14 confirmed line infections with a total of 33 suspected line infections being recorded, 10 line occlusions and 6 line breakages. There was a proven catheter sepsis rate of 1 catheter sepsis per 3.17 years with an overall suspected catheter sepsis rate of 1 suspected infection per 1.35 patient years. The overall proven line complication rate was 1 complication per 1.48 patient years. One patient was excluded from complication analysis as he was unable to grasp aseptic technique. Conclusions: HPN can be practised at DGH level achieving complication rates broadly comparable to large specialist centres, and this lends weight to the argument of using a "hub and spoke" model to widen provision of HPN beyond large specialist centres.


Related Articles

  • Primary intestinal lymphangiectasia successfully treated with octreotide. Kuroiwa, Ganji; Takayama, Tetsuji; Sato, Yasushi; Takahashi, Yasuo; Fujita, Tomoki; Nobuoka, Atsushi; Kukitsu, Takehiro; Kato, Junji; Sakamaki, Sumio; Niitsu, Yoshiro // Journal of Gastroenterology;2001, Vol. 36 Issue 2, p129 

    Abstract: A 21-year-old man with diarrhea and edema was admitted to our hospital and diagnosed with protein-losing enteropathy caused by primary intestinal lymphangiectasia. He was placed, in turn, on a low-fat diet, an elemental diet, and, subsequently, fasting therapy with total parenteral...

  • Parenteral nutrition.  // Gut;Jul2012 Supplement, Vol. 61, pA96 

    The article presents abstracts on medical topics of Great Britain which include parenteral nutrition, knowledge of intravenous fluid therapy and the impact of the multidisciplinary nutrition support team on the parenteral nutrition.

  • Gallbladder Motility and Cholecystokinin Secretion during Continuous Enteral Nutrition. Ledeboer, Michiel; Masclee, Ad A. M.; Biemond, Izäk; Lamers, Cornelis B. H. W. // American Journal of Gastroenterology;Dec1997, Vol. 92 Issue 12, p2274 

    Objectives: During total parenteral nutrition, gallbladder motility is impaired, resulting in sludge and stone formation. Little is known about gallbladder motility during prolonged enteral nutrition. Methods: We studied gallbladder motility during continuous enteral nutrition (CEN) in nine...

  • Intravenous feeding in infancy.  // British Medical Journal;6/11/1977, Vol. 1 Issue 6075, p1490 

    Focuses on intravenous feeding of newborn babies. Management of chronic gastrointestinal disease; Risk associated with feeding; Need for monitoring and aseptic control of foods.

  • An Integrated Approach to Intestinal Failure: Results of a New Program With Total Parenteral Nutrition, Bowel Rehabilitation, and Transplantation Fishbein, Thomas M.; Schiano, Thomas; LeLeiko, Neil; Facciuto, Marcelo; Ben-Haim, Menahem; Emre, Sukru; Sheiner, Patricia A.; Schwartz, Myron E.; Miller, Charles M. // Journal of Gastrointestinal Surgery;Jul2002, Vol. 6 Issue 4, p554 

    Intestinal failure can be treated with bowel rehabilitation, total parenteral nutrition, or intestinal transplantation. Little has been done to integrate these therapies for patients with intestinal insufficiency or failure and to develop an algorithm for appropriate use and timing. We...

  • Regionally acquired intestinal failure data suggest an underestimate in national service requirements. Barclay, A. R.; Paxton, C. E.; Gillett, P.; Hoole, D.; Livingstone, J.; Young, D.; Menon, G.; Munro, F.; Wilson, D. C. // Archives of Disease in Childhood -- Fetal & Neonatal Edition;Dec2009, Vol. 94 Issue 12, p12 

    Objectives, setting and patients: With complete case referral for prolonged parenteral nutrition (PN) beyond term equivalent, serving a stable population of 1.25 million people, we describe the long-term outcome and survival of patients referred to an intestinal failure (IF) nutrition support...

  • Evidence for Colonic Conservation of Malabsorbed Carbohydrate in Short Bowel Syndrome. Royall, Dawna; Wolever, Thomas M. S.; Jeejeebhoy, Khursheed N. // American Journal of Gastroenterology;Jun1992, Vol. 87 Issue 6, p751 

    The purpose of this study was to determine whether energy from malabsorbed carbohydrate could be conserved through colonic fermentation in short bowel syndrome. Seven patients with short bowel anastomosed to the remaining colon and five patients with short bowel without a colon were selected...

  • Intestinal Rehabilitation and the Short Bowel Syndrome: Part 1. DiBaise, John K.; Young, Rosemary J.; Vanderhoof, Jon A. // American Journal of Gastroenterology;Jul2004, Vol. 99 Issue 7, p1386 

    The management of patients with intestinal failure due to short bowel syndrome (SBS) is complex, requiring a comprehensive approach that frequently necessitates long-term, if not life-long, use of parenteral nutrition (PN). Despite tremendous advances in the provision of PN over the past three...

  • Serial transverse enteroplasty (STEP): intermediate outcomes in children with short bowel syndrome. Lourenço, Lara; Campos, Miguel; Monteiro, Joaquim; Trindade, Eunice; Dias, Jorge; Guerra, António; Guerra, Paula; Correia-Pinto, Jorge; Estevão-Costa, José // European Journal of Pediatrics;Aug2012, Vol. 171 Issue 8, p1265 

    Short bowel syndrome is the most common cause of intestinal failure in children. The treatment is based on a multidisciplinary approach involving pediatricians, pediatric surgeons, and nutritionists. Surgical procedures for intestinal lengthening may be decisive, having been revalued after the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics