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PP126-MON ROUTINE DRESSING CHANGE AT THE INSERTION POINT REDUCES THE INCIDENCE OF CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION
Nutritional assessment II well-nourished, moderatley malnourished and severely malnourshed respectively (p = 0.048). Conclusion: Using the scored PG-SGA, this study observed a correlation between severity of nutritional status and increased length of hospital stay among cancer patients. Presence of nutritional impact symptoms correlated with the degree of malnutrition on admission. Disclosure of Interest: None Declared.
PP124-MON Outstanding abstract NUTRITIONAL RISK SCREENING (NRS 2002) IN HOSPITALIZED PATIENTS IN A GASTROENTEROLOGICAL DEPARTMENT: IMPLEMENTATION OF A LARGE-SCALE SYSTEMATIC STRATEGY M. Arvanitakis1,2 , A. Ballarin2 , S. Vereecken2,3 , A. Van Gossum1,2 . 1 Gastroenterology, 2 Nutrition Team, 3 Dietary Department, Hˆ opital Universitaire Erasme, ULB, Brussels, Belgium Rationale: The Nutritional Risk Screening (NRS 2002) is recommended for hospitalized patients. However, studies assessing large-scale systematic screening policies are lacking. The aim of this study, which was endorsed by the Ministry of Health, was to assess the feasibility of implementing a screening strategy concerning all admissions in a Gastroenterology medico-surgical department of a tertiary hospital. Methods: All patients admitted in the Gastroenterology department, between 1/01 and 31/12/2011, with an estimated length of stay over 48 hours, were screened with the NRS 2002 by the nursing staff on the day of their admission. If the pre-screening was positive, the patient was referred for a complementary assessment performed by a dietician. Results: The global number of admissions in our institution was 28,377 patients; 4667 patients were admitted in the Gastroenterology department. The NRS 2002 was performed in 2019 patients. A positive pre-screening test was recorded in 756 (37%). 505/756 patients (67%) were assessed by a dietician and the nutrition team, if deemed necessary. 251 patients were not further assessed despite a positive pre-screening test because of logistic issues (lack of a sufficient number of dieticians). A NRS 3 was found in 62%. All 505 patients with a positive pre-screening received initial nutritional support by oral supplements and/or enteral nutrition if necessary (n = 130). The mean length of stay for all 2019 patients was 6.9 days. However, the length of stay was significantly longer for patients with a positive NRS 2002, with a mean of 18 days (P = 0.01). Conclusion: An important number of hopitalized patients are at a nutritional risk and have a significantly longer stay. Although systematic screening by the nursing staff seems feasible, complementary evaluation and management still requires improvement by reinforcing the dietician department. Disclosure of Interest: None Declared.
187 PP125-MON PROGRESSIVE VS FULL PLANNED ENERGY LOAD AT THE BEGINNING OF PARENTERAL NUTRITION: EFFECT ON ENERGY CONSUMPTION M. Ławi´ nski1 , A. Goszczy´ nska2 , A. Bzikowska2 , M. Pertkiewicz1 . 1 Department of General Surgery and Clinical Nutrition, 2 Student, Medical University of Warsaw, Warsaw, Poland Rationale: Harris Benedict formula is used for calculation resting energy expenditure (REE) for planning parenteral nutrition energy intake. Parenteral nutrition (PN) usually supplies full estimated energy requirement from the very beginning. In starved patients progressive increase is suggested in order to avoid metabolic stress. Aim was to compare energy consumption in response to gradual vs full energy supply. Methods: Starved or semi-starved 21 non-septic patients. In 10 patients (f:m 3:7, age 54±21 years, Group A) PN was increased gradually and in 11 (f:m 2:9, age 62±12 years, group B) full planned energy intake was infused from the first day. REE was measured using Medgraphics CCM Express 2 hours after termination of infusion before and after 1st until 4th PN day. Results: Calculated vs. measured REE was (1319±229 vs. 1128±340 kcal/24 p < 0.01). Measured REE didn’t increased with PN supply in both groups. During starvation the patients utilized mainly fat and with PN they start to utilize carbohydrates. This change was more pronounced in patients who received full PN supply from the beginning.
REEkcal/24hIC Group A Group B Intake, kcal Group A Group B FAT/REE, % Group A Group B CHO/REE, % Group A Group B
Before
1st PN
2nd PN
4th PN
p0 vs 4th
1196±342 1087±335
1283±259 1060±197
1193±222 1033±303
1234±229 1053±349
p < 0.4 p < 0.27
0 0
972±102 1161±200
1016±201 1161±200
1207±228 1161±200
p < 0.0002 n.s.
75±26 57±27
60±26 42±26
57±30 39±24
55.2±30 34±14
p < 0.005 p < 0.002
24±25 41±26
40±26 57±26
42±30 61±24
44.5±31 66±14
p < 0.002 p < 0.001
Conclusion: Harris Benedict formula overestimate REE. Lipid tissue was the main energy source in starvation before TPN. In starved nonseptic patients TPN did not increased energy consumption, but CHO and fat were utilized in different degree depending on method of PN implementation on given level of energy intake. Disclosure of Interest: None Declared.
PP126-MON ROUTINE DRESSING CHANGE AT THE INSERTION POINT REDUCES THE INCIDENCE OF CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION M. Ishizuka1 , H. Nagata1 , K. Takagi1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: Routine dressing change (R-DC) at the point of insertion of a central venous catheter (CVC) is considered to confer a lower risk of central venous catheter-related bloodstream infection (CVC-RBSI) than
188 non-routine dressing change (NR-DC). The purpose of this study is to compare the time interval from insertion until development of CVC-RBSI between patients who received NR-DC (Group 1) and patients who received R-DC (Group 2). Methods: Between March 2006 and July 2008, patients who underwent CVC were randomly divided into Groups 1 and 2. Comparative study between the two groups was performed by reference to the incidences of CVC-RBSI from the prospectively obtained database. Results: One hundred eighty-nine patients underwent 530 CVC insertions. Group 1 had 254 CVCs and Group 2 had 276 CVCs. There were no significant inter-group differences in patient background factors, except for sex. In addition, Group 1 had a shorter duration of catheter insertion than Group 2. Nevertheless, Group 1 had not only a significantly shorter period from insertion until the development of CVC-RBSI but also a higher frequency of fever than Group 2. Conclusion: The results of our comparison between NR-DC and R-DC indicate that R-DC can reduce the incidence of CVC-RBSI in patients undergoing CVC insertions. References Adal KA, Farr BM. Central venous catheter-related infections: a review. Nutrition 1996; 12: 208 213. Bacuzzi A, Cecchin A, Del Bosco A, Cantone G, Cuffai S. Recommendations and reports about central venous catheterrelated infection. Surg Infect 2006; 7: 65 67. Disclosure of Interest: None Declared.
PP127-MON PARENTERAL NUTRITION IS ASSOCIATED WITH CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION IN COLORECTAL CANCER PATIENTS RECEIVING POSTOPERATIVE CHEMOTHERAPY M. Ishizuka1 , H. Nagata1 , K. Takagi1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: To clarify the risk factors for central venous catheter-related bloodstream infection (CVC-RBSI) in patients receiving chemotherapy after surgery for colorectal cancer (CRC). Methods: CVC-RBSI was evaluated retrospectively from a database of patients who had received postoperative chemotherapy using CVC. Results: One hundred nine patients received 542 CVCs for a total of 5558 catheter-days. There were no significant differences in background between the patients who had CVC-RBSI and those who did not, except for the term of insertion (P = 0.0028) and administration of parenteral nutrition (PN) (P < 0.0001). Moreover, univariate analyses using factors including type of catheter, sex, age, troubles with insertion, types of disinfectant, types of catheter, length of inserted catheter, period of insertion, and administration of PN revealed that administration of PN (odds ratio, 12.74; 95% CI, 2.489 62.26; P = 0.0023) was risk factors for CVC-RBSI. Conclusion: PN is associated with CVC-RBSI in CRC patients receiving postoperative chemotherapy.
Poster presentations References Dissanaike S, Shelton M, Warner K, et al.: The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care 2007. Tacconelli E, Tumbarello M, Pittiruti M, et al.: Central venous catheter-related sepsis in a cohort of 366 hospitalised patients. Eur J Clin Microbiol Infect Dis 1997; 16: 203 209. Disclosure of Interest: None Declared.
PP128-MON NUTRITIONAL STATUS OF PATIENTS SUBJECTED TO HEMATOPOIETIC STEM CELL TRANSPLANTATION INTERIM REPORT J. Krawczyk1 , G.W. Basak1 , K. Hałaburda1 , T. Korta2 , L. Kraj1,3 , A. ´ Swieboda-Sadlej1 , W.W. Je˛drzejczak1 . 1 Department of Hematology, Oncology and Internal Diseases, 2 2nd Clinic of Anesthesiology and Intensive Care, 3 Department of Biochemistry, Medical University of Warsaw, Warsaw, Poland Rationale: Hematopoietic stem cell transplantation (HSCT) is an aggressive method of treatment which significantly affects patients’ homeostasis, including the nutritional status. The aim of the work was to evaluate the nutritional status of patients before the intensive preparatory treatment (conditioning) and within the first two weeks following the procedure. Methods: The prospective study included consecutive patients with hematological malignancies subjected to HSCT (62 autologous, 38 allogeneic) in a single transplantation centre. The assessment of the nutritional status was made using the Nutritional Risk Screening 2002 (NRS), Subjective Global Assessment (SGA), anthropometric and biochemical parameters. For statistical analyses, the Wilcoxon test was used. Results: Before conditioning the median result of NRS was 3 points and the most frequent of SGA result was A (88%). The median body weight was 78 kg, BMI 26 kg/m2 , concentration of total protein (TP) 6.8 g/dl, albumin (A) 4.2 g/dl, transferrin (Tr) 228 mg/dl. The frequency of overweight and obesity were 42% and 25%, respectively. On the day +7 following HSCT the median result of NRS was 4 points; on the SGA results A and B were noted in 62% and 31%, respectively. The median body weight was 75 kg, BMI 25 kg/m2 . We observed a significant decrease in concentration of TP (5.8 g/dl), A (3.6 g/dl), Tr (165 mg/dl) p < 0.001. On the day +14, the biochemical parameters were even lower: TP 5.5 g/dl, A 3.2 g/dl, Tr 144 mg/dl, p < 0.001. These values did not significantly differ between patients after allogeneic or autologous HSCT. Conclusion: Before conditioning, the majority of patients did not display undernutrition features, while overweight and obesity were frequent. During treatment, the nutritional status deteriorated. The patients subjected to HSCT required regular nutritional status assessment. Disclosure of Interest: None Declared.
PP124-MON Outstanding abstract NUTRITIONAL RISK SCREENING (NRS 2002) IN HOSPITALIZED PATIENTS IN A GASTROENTEROLOGICAL DEPARTMENT: IMPLEMENTATION OF A LARGE-SCALE SYSTEMATIC STRATEGY M. Arvanitakis1,2 , A. Ballarin2 , S. Vereecken2,3 , A. Van Gossum1,2 . 1 Gastroenterology, 2 Nutrition Team, 3 Dietary Department, Hˆ opital Universitaire Erasme, ULB, Brussels, Belgium Rationale: The Nutritional Risk Screening (NRS 2002) is recommended for hospitalized patients. However, studies assessing large-scale systematic screening policies are lacking. The aim of this study, which was endorsed by the Ministry of Health, was to assess the feasibility of implementing a screening strategy concerning all admissions in a Gastroenterology medico-surgical department of a tertiary hospital. Methods: All patients admitted in the Gastroenterology department, between 1/01 and 31/12/2011, with an estimated length of stay over 48 hours, were screened with the NRS 2002 by the nursing staff on the day of their admission. If the pre-screening was positive, the patient was referred for a complementary assessment performed by a dietician. Results: The global number of admissions in our institution was 28,377 patients; 4667 patients were admitted in the Gastroenterology department. The NRS 2002 was performed in 2019 patients. A positive pre-screening test was recorded in 756 (37%). 505/756 patients (67%) were assessed by a dietician and the nutrition team, if deemed necessary. 251 patients were not further assessed despite a positive pre-screening test because of logistic issues (lack of a sufficient number of dieticians). A NRS 3 was found in 62%. All 505 patients with a positive pre-screening received initial nutritional support by oral supplements and/or enteral nutrition if necessary (n = 130). The mean length of stay for all 2019 patients was 6.9 days. However, the length of stay was significantly longer for patients with a positive NRS 2002, with a mean of 18 days (P = 0.01). Conclusion: An important number of hopitalized patients are at a nutritional risk and have a significantly longer stay. Although systematic screening by the nursing staff seems feasible, complementary evaluation and management still requires improvement by reinforcing the dietician department. Disclosure of Interest: None Declared.
187 PP125-MON PROGRESSIVE VS FULL PLANNED ENERGY LOAD AT THE BEGINNING OF PARENTERAL NUTRITION: EFFECT ON ENERGY CONSUMPTION M. Ławi´ nski1 , A. Goszczy´ nska2 , A. Bzikowska2 , M. Pertkiewicz1 . 1 Department of General Surgery and Clinical Nutrition, 2 Student, Medical University of Warsaw, Warsaw, Poland Rationale: Harris Benedict formula is used for calculation resting energy expenditure (REE) for planning parenteral nutrition energy intake. Parenteral nutrition (PN) usually supplies full estimated energy requirement from the very beginning. In starved patients progressive increase is suggested in order to avoid metabolic stress. Aim was to compare energy consumption in response to gradual vs full energy supply. Methods: Starved or semi-starved 21 non-septic patients. In 10 patients (f:m 3:7, age 54±21 years, Group A) PN was increased gradually and in 11 (f:m 2:9, age 62±12 years, group B) full planned energy intake was infused from the first day. REE was measured using Medgraphics CCM Express 2 hours after termination of infusion before and after 1st until 4th PN day. Results: Calculated vs. measured REE was (1319±229 vs. 1128±340 kcal/24 p < 0.01). Measured REE didn’t increased with PN supply in both groups. During starvation the patients utilized mainly fat and with PN they start to utilize carbohydrates. This change was more pronounced in patients who received full PN supply from the beginning.
REEkcal/24hIC Group A Group B Intake, kcal Group A Group B FAT/REE, % Group A Group B CHO/REE, % Group A Group B
Before
1st PN
2nd PN
4th PN
p0 vs 4th
1196±342 1087±335
1283±259 1060±197
1193±222 1033±303
1234±229 1053±349
p < 0.4 p < 0.27
0 0
972±102 1161±200
1016±201 1161±200
1207±228 1161±200
p < 0.0002 n.s.
75±26 57±27
60±26 42±26
57±30 39±24
55.2±30 34±14
p < 0.005 p < 0.002
24±25 41±26
40±26 57±26
42±30 61±24
44.5±31 66±14
p < 0.002 p < 0.001
Conclusion: Harris Benedict formula overestimate REE. Lipid tissue was the main energy source in starvation before TPN. In starved nonseptic patients TPN did not increased energy consumption, but CHO and fat were utilized in different degree depending on method of PN implementation on given level of energy intake. Disclosure of Interest: None Declared.
PP126-MON ROUTINE DRESSING CHANGE AT THE INSERTION POINT REDUCES THE INCIDENCE OF CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION M. Ishizuka1 , H. Nagata1 , K. Takagi1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: Routine dressing change (R-DC) at the point of insertion of a central venous catheter (CVC) is considered to confer a lower risk of central venous catheter-related bloodstream infection (CVC-RBSI) than
188 non-routine dressing change (NR-DC). The purpose of this study is to compare the time interval from insertion until development of CVC-RBSI between patients who received NR-DC (Group 1) and patients who received R-DC (Group 2). Methods: Between March 2006 and July 2008, patients who underwent CVC were randomly divided into Groups 1 and 2. Comparative study between the two groups was performed by reference to the incidences of CVC-RBSI from the prospectively obtained database. Results: One hundred eighty-nine patients underwent 530 CVC insertions. Group 1 had 254 CVCs and Group 2 had 276 CVCs. There were no significant inter-group differences in patient background factors, except for sex. In addition, Group 1 had a shorter duration of catheter insertion than Group 2. Nevertheless, Group 1 had not only a significantly shorter period from insertion until the development of CVC-RBSI but also a higher frequency of fever than Group 2. Conclusion: The results of our comparison between NR-DC and R-DC indicate that R-DC can reduce the incidence of CVC-RBSI in patients undergoing CVC insertions. References Adal KA, Farr BM. Central venous catheter-related infections: a review. Nutrition 1996; 12: 208 213. Bacuzzi A, Cecchin A, Del Bosco A, Cantone G, Cuffai S. Recommendations and reports about central venous catheterrelated infection. Surg Infect 2006; 7: 65 67. Disclosure of Interest: None Declared.
PP127-MON PARENTERAL NUTRITION IS ASSOCIATED WITH CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION IN COLORECTAL CANCER PATIENTS RECEIVING POSTOPERATIVE CHEMOTHERAPY M. Ishizuka1 , H. Nagata1 , K. Takagi1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: To clarify the risk factors for central venous catheter-related bloodstream infection (CVC-RBSI) in patients receiving chemotherapy after surgery for colorectal cancer (CRC). Methods: CVC-RBSI was evaluated retrospectively from a database of patients who had received postoperative chemotherapy using CVC. Results: One hundred nine patients received 542 CVCs for a total of 5558 catheter-days. There were no significant differences in background between the patients who had CVC-RBSI and those who did not, except for the term of insertion (P = 0.0028) and administration of parenteral nutrition (PN) (P < 0.0001). Moreover, univariate analyses using factors including type of catheter, sex, age, troubles with insertion, types of disinfectant, types of catheter, length of inserted catheter, period of insertion, and administration of PN revealed that administration of PN (odds ratio, 12.74; 95% CI, 2.489 62.26; P = 0.0023) was risk factors for CVC-RBSI. Conclusion: PN is associated with CVC-RBSI in CRC patients receiving postoperative chemotherapy.
Poster presentations References Dissanaike S, Shelton M, Warner K, et al.: The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care 2007. Tacconelli E, Tumbarello M, Pittiruti M, et al.: Central venous catheter-related sepsis in a cohort of 366 hospitalised patients. Eur J Clin Microbiol Infect Dis 1997; 16: 203 209. Disclosure of Interest: None Declared.
PP128-MON NUTRITIONAL STATUS OF PATIENTS SUBJECTED TO HEMATOPOIETIC STEM CELL TRANSPLANTATION INTERIM REPORT J. Krawczyk1 , G.W. Basak1 , K. Hałaburda1 , T. Korta2 , L. Kraj1,3 , A. ´ Swieboda-Sadlej1 , W.W. Je˛drzejczak1 . 1 Department of Hematology, Oncology and Internal Diseases, 2 2nd Clinic of Anesthesiology and Intensive Care, 3 Department of Biochemistry, Medical University of Warsaw, Warsaw, Poland Rationale: Hematopoietic stem cell transplantation (HSCT) is an aggressive method of treatment which significantly affects patients’ homeostasis, including the nutritional status. The aim of the work was to evaluate the nutritional status of patients before the intensive preparatory treatment (conditioning) and within the first two weeks following the procedure. Methods: The prospective study included consecutive patients with hematological malignancies subjected to HSCT (62 autologous, 38 allogeneic) in a single transplantation centre. The assessment of the nutritional status was made using the Nutritional Risk Screening 2002 (NRS), Subjective Global Assessment (SGA), anthropometric and biochemical parameters. For statistical analyses, the Wilcoxon test was used. Results: Before conditioning the median result of NRS was 3 points and the most frequent of SGA result was A (88%). The median body weight was 78 kg, BMI 26 kg/m2 , concentration of total protein (TP) 6.8 g/dl, albumin (A) 4.2 g/dl, transferrin (Tr) 228 mg/dl. The frequency of overweight and obesity were 42% and 25%, respectively. On the day +7 following HSCT the median result of NRS was 4 points; on the SGA results A and B were noted in 62% and 31%, respectively. The median body weight was 75 kg, BMI 25 kg/m2 . We observed a significant decrease in concentration of TP (5.8 g/dl), A (3.6 g/dl), Tr (165 mg/dl) p < 0.001. On the day +14, the biochemical parameters were even lower: TP 5.5 g/dl, A 3.2 g/dl, Tr 144 mg/dl, p < 0.001. These values did not significantly differ between patients after allogeneic or autologous HSCT. Conclusion: Before conditioning, the majority of patients did not display undernutrition features, while overweight and obesity were frequent. During treatment, the nutritional status deteriorated. The patients subjected to HSCT required regular nutritional status assessment. Disclosure of Interest: None Declared.