Home Parenteral Nutrition is a therapeutic option to improve quality of life in chronic intestinal failure.
Aims
To describe frequency of complications both in cancer and non-cancer patients.
Methods
This study was performed on 270 adult patients (52% with cancer, 48% without cancer) followed for a total of 371 years of treatment. Mean duration of therapy was 191±181 for cancer and 830±1168 days/patient for non-cancer. The treatment was administered by a competent, dedicated provider. Patients received our prescribed “all-in-one admixtures” at their homes.
Results
Catheter-related complications/1000-days-catheter was 1.40; mechanical complications were comparable in cancer (0.82) and non-cancer (0.91) patients while a statistically significant difference was observed between cancer (0.71) and non-cancer (0.46) patients for sepsis. Bacterial infections were more frequent in non-cancer, mycotic infections primarily affected cancer patients. In our experience 49% of the patients were readmitted, with a low incidence rate of 0.89/1000 days-catheter. The incidence of hepatobiliary complications in our population was 65%. The degree of liver damage was related to short bowel syndrome and to length of treatment.
Conclusions
This study indicated that cancer patients are more vulnerable to CVC-related infections during Home Parenteral Nutrition and that a safer Home Parenteral Nutrition protocol should be adopted in order to contain CVC-related complications.
DiamantiA., PanettaF., TentoliniA.. The management of children with chronic diseases on enteral nutrition.Nutritional Therapy & Metabolism2011; 29(4): 208–12.
2.
SpagnuoloM.I., PirozziM.R., GuarinoA.Enteral and parenteral nutrition in pediatric patients: main clinical indications and the fundamental role of artificial nutrition to avoid malnutrition.Nutritional Therapy & Metabolism2010; 28(1): 21–4.
3.
DiamantiA.Enteral formulas in children: which is the best choice?Nutritional Therapy & Metabolism2010; 28(1): 40–5.
4.
SilvestriV., MazzuoliS., ReganoN.. The practical utility of guidelines in medicine and artificial nutrition.Nutritional Therapy & Metabolism2008; 26(2): 59–64.
5.
GouletO.Long-term parenteral nutrition in pediatrics.Nutritional Therapy & Metabolism2007; 25(1): 12–5.
6.
CencicA., ChingwaruW., MicovicE.Use of dietary supplements against malnutrition –opportunity for healthier living?Nutritional Therapy & Metabolism2011; 29(1): 30–46.
7.
LupattelliM.R., MarchettiG., PostorinoM.. Total parenteral nutrition enriched with glutamine and ω-3 fatty acid in adult patients undergoing autologous stem cell transplantation.Nutritional Therapy & Metabolism2009; 27(1): 39–45.
8.
PironiL., PaganelliF., LabateA.M.. Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single centre.Dig Liver Dis.2003; 5(5): 314–24.
9.
Izquierdo-GarcíaE., Fernández-FerreiroA., Gomis-MuñozP., Herreros de TejadaA., Moreno-VillaresJ.M.Liver disease associated with short-term total parenteral nutrition in a pediatric hospital through the course of the year 2008.Nutritional Therapy Metabolism2011; 29(3): 124–33.
10.
MamidiR.S., KulkarniB., RadhakrishnaK.V.Hospital-based nutrition rehabilitation of children with severe acute malnutrition – experiences from a nutrition center in India.Nutritional Therapy Metabolism2011; 29(3): 107–18.
11.
SantiniE.Best practices in enteral nutrition.Nutritional Therapy Metabolism2010; 28(2): 64–7.
12.
PironiL., GuidettiM., LanzoniE.. Impact of long-term home parenteral nutrition on bone metabolism and mineral density: a case report.Nutritional Therapy & Metabolism2008; 26(2): 86–92.
13.
FinocchiaroE., RahimiF., AgnelloE.. Home parenteral nutrition in advanced cancer patients: a four-years multicenter prospective observational study.Nutritional Therapy & Metabolism2007; 25(1): 31–9.
14.
MazzuoliS., FregnanS., LeograndeG., GuglielmiA., ColucciG., GuglielmiF.W.Handgrip strength and malnutrition in cancer patients.Nutritional Therapy Metabolism2011; 29(2): 88–94.
15.
Moreno VillaresJ.M., MurilloM.R., FuentesC.G.Nutrition support in patients with chronic intestinal pseudo-obstruction.Nutritional Therapy Metabolism2010; 28(3): 110–6.
16.
SantarpiaL., PaganoM.C., ContaldoF.Home artificial nutrition in Southern Italy: an update four years after the regional regulation.Nutritional Therapy & Metabolism2010; 28(2): 57–63.
17.
RhodaK.M., SuryadevaraS., SteigerE.Home Parenteral Nutrition support for intestinal failure.Surg Clin North Am.2011; 91(4): 913–32.
PironiL., ForbesA., JolyF.. Survival of patients identified as candidates for intestinal transplantation: a 3-year prospective follow up.Gastroenterology2008; 135(1): 61–71.
20.
GuglielmiF.W., ReganoN., MazzuoliS.. Cholestasis induced by total parenteral nutrition.Clin Liv Dis2008; 12(1): 97–110.
21.
VafaH., BallarinA., ArvanitakisM.. Lessons from a 20 year experience of Home Parenteral Nutrition in adult patients.Acta Gastroenterol Belg2010; 73(4): 451–6.
22.
RévillonY., ChardotC.Indications and strategies for intestinal transplantation.J Pediatr Surg2011; 46(2): 280–3.
23.
StaunM., PironiL., BozzettiF.. ESPEN Guidelines on Parenteral Nutrition: Home Parenteral Nutrition (HPN) in adult patients.Clin Nutr2009; 28(4): 467–79.
24.
PittirutiM., HamiltonH., BiffiR.. ESPEN Guidelines on Parenteral Nutrition: Central Venous Catheters (access, care, diagnosis and therapy of complications).Clin Nutr2009; 28(4): 365–77.
25.
GuglielmiF.W., PencoJ.M.M., GentileA.. Hepatobiliary complications of long-term home parenteral nutrition.Clin Nutr2001, 20(Supp 2): 51–5.
GuglielmiF.W., ReganoN., MazzuoliS.. Cholestasis induced by total parenteral nutrition.Clin Liver Dis;2008, 12(1): 97–110.
28.
BurstyneM., JensenG.L.Abnormal liver function following total parenteral nutrition in a patient with short bowel syndrome.Nutrition.2000; 16(11-12): 1090–2.
29.
Della LoggiaP., KirenV., GiacomazziD.. Parenteral nutritional therapy and risk of infection: review with proposed management guidelines.Nutritional Therapy & Metabolism2009; 27(1): 23–32.
30.
PittirutiM., ScoppettuoloG., EmoliA.. Parenteral nutrition through ultrasound-placed PICCs and midline catheters is associated with a low rate of complications: an observational study.Nutritional Therapy & Metabolism2009; 27(3): 142–8.
31.
RoveraG.M., FransosL., CenaH.. Critical illness and hyperglycemia management in parenteral and enteral nutrition.Nutritional Therapy & Metabolism2008; 26(4): 170–176.
GandulliaP., LuganiF., CostabelloL.. Long-term home parenteral nutrition in children with chronic intestinal failure: A 15-year experience at a single Italian centre.Dig Liver Dis.2011; 43(1): 28–33.
34.
National Advisory Group on Standards and Practice Guidelines for Parenteral Nutrition.Safe Practices for Parenteral Nutrition Formulations.JPEN J Parenter Enteral Nutr.1998; 22(2): 49–66.
35.
A statement by the Nutrition Advisory Group.American Medical Association Department of Foods and Nutrition, 1975. Multivitamin preparations for parenteral use.JPEN J Parenter Enteral Nutr.1979; 3(4): 258–62.
36.
JeejebhoyK.N.Micronutrients – State of the art.New Aspects of Clinical Nutrition.Basel: Karger, 1983: 1–24.
37.
Linee guida SINPE per la Nutrizione Artificiale Ospedaliera 2002.Rivista Italiana di Nutrizione Parenterale ed Enterale2002; 20(S5): S1–S171.
38.
TokarsJ.I., CooksonS.T., McArthurM.A.. Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy.Ann Intern Med;1999; 131(5): 340–7.
39.
ScolapioJ.S., FlemingC.R., KellyD.G.. Survival of home parenteral nutrition-treated patients: 20 years of experience at the Mayo Clinic.Mayo Clin Proc.1999; 74(3): 217–22.
40.
BonifacioR., AlfonsiL., SantarpiaL.. Clinical outcome of long-term home parenteral nutrition in non-oncological patients: a report from two specialised centres.Intern Emerg Med2007; 2(3): 188–95.
41.
PironiL., JolyF., ForbesA.Home Artificial Nutrition & Chronic Intestinal Failure Working Group of the European Society for Clinical Nutrition and Metabolism (ESPEN). Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation.Gut2011; 60(1): 17–25.
