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PP184-MON POSTOPERATIVE EARLY ENTERAL NUTRITION USING THE HIGH-ENERGY AND HIGH-PROTEIN ENTERAL FORMULA, COMPARING WITH USING THE REGULAR TYPE ENTERAL FORMULA
Nutritional techniques and formulations II and 27 total occlusions in 19 patients. The rate of CRBSI in this group was 0.02 CRBSI/1000 catheter days in the 2 year period assessed. This compares with a rate in patients not suffering occlusions of 0.91 CRBSI/ 1000 catheter days. Occlusion type
Outcome
Cause
Partial (11) 10 success (91%) 10 lipid 1 failed (9%) 1 lipid Full (27) 22 success (81%) 7 fibrin 5 lipid 10 unknown 5 failed (19%) 2 fibrin 1 lipid 1 mixed 1 unknown
Methods used 9H, 8M, 8S, 1A, 1U H, M, S, A 22M, 22S, 5H (with lipid), 3U, 2A 5M, 4U, 3S, 2H, 1A
Conclusion: Line manipulation, persistent pulsatile flushing and hub clearout with a needle are safe and effective for CVC salvage. Alcohol and urokinase have a role but are often not required and may not work alone. Postsalvage complications are rare. The apparent negative association between occlusion and infection runs contrary to the belief that infection and occlusion are linked, and warrants further study. Disclosure of Interest: None Declared.
PP184-MON POSTOPERATIVE EARLY ENTERAL NUTRITION USING THE HIGH-ENERGY AND HIGH-PROTEIN ENTERAL FORMULA, COMPARING WITH USING THE REGULAR TYPE ENTERAL FORMULA M.J. Maruyama1 . 1 Department of Surgery, Tokyo Metropolitan Ohkubo Hospital, Sinjyukuku, Japan Rationale: The regular type enteral formula is not able to provide enough energy and protein for the patients in the postoperative early phase (the first 3 4 post-operative days). When the patients receive the high-energy and high-protein enteral formula for the postoperative early enteral nutrition, the patients might show the early recovery after surgery. Methods: 12 gastric cancer patients who undertook the gastric surgery were enrolled for this trial. 6 patients (trial group) received the high-energy and high-protein enteral formula (1.5 kcal/ml, protein 9.5 g/100 ml), and 6 patients (control group) received the regular type enteral formula (1.0 kcal/ml, protein 4 g/100 ml). The velocity of postoperative early enteral nutrition through the jejunostomy is 10 ml/h on 1POD, 20 ml/h on 2POD, 40 ml/h on 3POD, 60 ml/h on 4POD-6POD. Results: The background of the two groups showed no significant difference. N-balance of trial group was statistically superior to control group after 2POD up to 6POD (P < 0.05). The BS and BUN serum levels of trial group seemed higher but showed no statistical difference. All cases of trial group showed the relatively high BUN levels more than 20 mg/dl on 6POD. Conclusion: N-balance of this trial showed the early positivity in the trial group. The usage of the high-energy and high-protein enteral formula should be considered for the postoperative early enteral nutrition for the first 3 4 days. Disclosure of Interest: None Declared.
211 PP185-MON COMPARISON OF PEPTAMEN AF® (HIGH-PROTEIN ENTERAL FORMULA) WITH MEIN® (NORMAL-PROTEIN ENTERAL FORMULA) IN SEVERE ACUTE STROKE PATIENTS REQUIRING TUBE FEEDING Y. Miyazaki1 , T. Mori1 , K. Mizokami1 , T. Iwata1 , M. Nakazaki1 . 1 The Department of Stroke Treatment, Stroke Center, Shonan Kamakura General Hospital, Kamakura, Japan Rationale: In patients fed with enteral nutrition following a severe acute stroke, nutritional state may rapidly deteriorate and clinical outcome may be unfavorable. However, it remains uncertain what an appropriate enteral nutrient for them is. The aim of our retrospective study is to investigate whether or not there are some differences of in-hospital clinical outcome in them between PEPTAMEN AF® , a high-protein immuno-moduating enteral diet (IMD), and MEIN® , a normal-protein IMD. Methods: Included for our analysis were acute stroke patients; (1) who were admitted to our institution from December 2010 to January 2012, (2) who were unable to take anything orally due to stroke and (3) who started to take enteral nutrition of PEPTAMEN AF® or MEIN® through an enteral feeding tube within 3 days of admission. Patients who died before the 4th hospital day due to fatal stroke were excluded. We evaluated basic characteristics, daily calorie intake (DCI), tolerance to tube feeding (TTF), stroke severity as measured by NIHSS on admission (adm) and 7th hospital day (day 7), inhospital mortality, serum albumin, BUN, and eGFR on adm and day 7. Results: 72 patients were included for our analysis. Among them, 37 patients took PEPTAMEN AF® (Group P) and 35 patients MEIN® (Group M). There were no significant differences between the two groups in terms of age, sex, DCI, TTF, NIHSS score on adm and day 7, serum albumin on adm and day 7, BUN on adm, and eGFR on adm and day 7. In-hospital mortality rate was significantly lower in Group P than in Group M (2.7% vs 22.9%, p < 0.05). BUN on day 7 was significantly higher in Group P than in Group M (median 35 mg/dl vs 23 mg/dl, p < 0.05). Conclusion: Compared to normal-protein IMD, highprotein IMD may support in-hospital survival in severe acute stroke patients who require enteral feeding, although it is at a risk of increase of BUN. Disclosure of Interest: None Declared.
PP186-MON REPAIR OF FRACTURED CENTRAL VENOUS CATHETERS FOR PARENTERAL NUTRITION: TECHNIQUES AND RISK OF INFECTION G.A.D. Major1 , M. Small1 , S. Gabe1 . 1 Lennard-Jones Intestinal Failure Unit, St Mark’s Hospital, London, United Kingdom Rationale: Tunnelled central venous catheters (CVCs) are the best method of vascular access for long-term parenteral nutrition. Failure of intravenous access can necessitate emergeny admission. Removing and replacing CVCs is painful, risks infection and venous thrombosis, and uses costly healthcare resources. Simple techniques
Outcome
Cause
Partial (11) 10 success (91%) 10 lipid 1 failed (9%) 1 lipid Full (27) 22 success (81%) 7 fibrin 5 lipid 10 unknown 5 failed (19%) 2 fibrin 1 lipid 1 mixed 1 unknown
Methods used 9H, 8M, 8S, 1A, 1U H, M, S, A 22M, 22S, 5H (with lipid), 3U, 2A 5M, 4U, 3S, 2H, 1A
Conclusion: Line manipulation, persistent pulsatile flushing and hub clearout with a needle are safe and effective for CVC salvage. Alcohol and urokinase have a role but are often not required and may not work alone. Postsalvage complications are rare. The apparent negative association between occlusion and infection runs contrary to the belief that infection and occlusion are linked, and warrants further study. Disclosure of Interest: None Declared.
PP184-MON POSTOPERATIVE EARLY ENTERAL NUTRITION USING THE HIGH-ENERGY AND HIGH-PROTEIN ENTERAL FORMULA, COMPARING WITH USING THE REGULAR TYPE ENTERAL FORMULA M.J. Maruyama1 . 1 Department of Surgery, Tokyo Metropolitan Ohkubo Hospital, Sinjyukuku, Japan Rationale: The regular type enteral formula is not able to provide enough energy and protein for the patients in the postoperative early phase (the first 3 4 post-operative days). When the patients receive the high-energy and high-protein enteral formula for the postoperative early enteral nutrition, the patients might show the early recovery after surgery. Methods: 12 gastric cancer patients who undertook the gastric surgery were enrolled for this trial. 6 patients (trial group) received the high-energy and high-protein enteral formula (1.5 kcal/ml, protein 9.5 g/100 ml), and 6 patients (control group) received the regular type enteral formula (1.0 kcal/ml, protein 4 g/100 ml). The velocity of postoperative early enteral nutrition through the jejunostomy is 10 ml/h on 1POD, 20 ml/h on 2POD, 40 ml/h on 3POD, 60 ml/h on 4POD-6POD. Results: The background of the two groups showed no significant difference. N-balance of trial group was statistically superior to control group after 2POD up to 6POD (P < 0.05). The BS and BUN serum levels of trial group seemed higher but showed no statistical difference. All cases of trial group showed the relatively high BUN levels more than 20 mg/dl on 6POD. Conclusion: N-balance of this trial showed the early positivity in the trial group. The usage of the high-energy and high-protein enteral formula should be considered for the postoperative early enteral nutrition for the first 3 4 days. Disclosure of Interest: None Declared.
211 PP185-MON COMPARISON OF PEPTAMEN AF® (HIGH-PROTEIN ENTERAL FORMULA) WITH MEIN® (NORMAL-PROTEIN ENTERAL FORMULA) IN SEVERE ACUTE STROKE PATIENTS REQUIRING TUBE FEEDING Y. Miyazaki1 , T. Mori1 , K. Mizokami1 , T. Iwata1 , M. Nakazaki1 . 1 The Department of Stroke Treatment, Stroke Center, Shonan Kamakura General Hospital, Kamakura, Japan Rationale: In patients fed with enteral nutrition following a severe acute stroke, nutritional state may rapidly deteriorate and clinical outcome may be unfavorable. However, it remains uncertain what an appropriate enteral nutrient for them is. The aim of our retrospective study is to investigate whether or not there are some differences of in-hospital clinical outcome in them between PEPTAMEN AF® , a high-protein immuno-moduating enteral diet (IMD), and MEIN® , a normal-protein IMD. Methods: Included for our analysis were acute stroke patients; (1) who were admitted to our institution from December 2010 to January 2012, (2) who were unable to take anything orally due to stroke and (3) who started to take enteral nutrition of PEPTAMEN AF® or MEIN® through an enteral feeding tube within 3 days of admission. Patients who died before the 4th hospital day due to fatal stroke were excluded. We evaluated basic characteristics, daily calorie intake (DCI), tolerance to tube feeding (TTF), stroke severity as measured by NIHSS on admission (adm) and 7th hospital day (day 7), inhospital mortality, serum albumin, BUN, and eGFR on adm and day 7. Results: 72 patients were included for our analysis. Among them, 37 patients took PEPTAMEN AF® (Group P) and 35 patients MEIN® (Group M). There were no significant differences between the two groups in terms of age, sex, DCI, TTF, NIHSS score on adm and day 7, serum albumin on adm and day 7, BUN on adm, and eGFR on adm and day 7. In-hospital mortality rate was significantly lower in Group P than in Group M (2.7% vs 22.9%, p < 0.05). BUN on day 7 was significantly higher in Group P than in Group M (median 35 mg/dl vs 23 mg/dl, p < 0.05). Conclusion: Compared to normal-protein IMD, highprotein IMD may support in-hospital survival in severe acute stroke patients who require enteral feeding, although it is at a risk of increase of BUN. Disclosure of Interest: None Declared.
PP186-MON REPAIR OF FRACTURED CENTRAL VENOUS CATHETERS FOR PARENTERAL NUTRITION: TECHNIQUES AND RISK OF INFECTION G.A.D. Major1 , M. Small1 , S. Gabe1 . 1 Lennard-Jones Intestinal Failure Unit, St Mark’s Hospital, London, United Kingdom Rationale: Tunnelled central venous catheters (CVCs) are the best method of vascular access for long-term parenteral nutrition. Failure of intravenous access can necessitate emergeny admission. Removing and replacing CVCs is painful, risks infection and venous thrombosis, and uses costly healthcare resources. Simple techniques