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PP204-SUN COMPARISON OF THE THREE-IN-ONE ADMIXTURES TO CONVENTIONAL PERIPHERAL PARENTERAL NUTRITION IN CHILDREN
S100 PP204-SUN COMPARISON OF THE THREE-IN-ONE ADMIXTURES TO CONVENTIONAL PERIPHERAL PARENTERAL NUTRITION IN CHILDREN H.R. Yang1 , D. Yi1 . 1 Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea, Republic Of Rationale: The aim of this study was to compare clinical aspects of the application of three-in-one (TNA) admixtures with those of conventional peripheral parenteral nutrition (cPPN) method in providing short-term nutritional support in children and adolescents. Methods: A retrospective study was conducted in children under 18 years of age who were hospitalized and underwent PPN supply at Seoul National University Bundang Hospital. Two methods of PPN were applied respectively, and the application of these two PPN were compared in all clinical aspects; TNA admixtures (n = 27) vs. cPPN (n = 21). Results: Comparing two groups, median ages were 7.6 years in TNA group and 6.4 years in cPPN group (P = 0.445). The beginning of PPN was faster in TNA group than in cPPN group (median 1.5 days vs. 3.5 days, P = 0.018). NPO duration up to the point of PPN was shorter in TNA group than in cPPN group (median 0.9 days vs. 2.1 days, P = 0.02). Although Glucose infusion rate (GIR) was lower in TNA group (median GIR 2.74 mg/kg/min vs. 5.14 mg/kg/min, P = 0.015), there were no significant differences in median total calories (34.5 kcal/kg/d vs. 43.3 kcal/kg/d, P = 0.897) and the amount of protein supply (median 1.15 g/kg/d vs. 1.42 g/kg/d, P = 0.851). The amount of lipid infused was higher in TNA group than cPPN group (median 1.38 g/kg/d vs. 1.06 g/kg/d, P = 0.042). Metabolic complications were not observed in both groups. Phlebitis was noted in 14 (51.9%) of 27 in TNA group and 13 (61.9%) of 21 in cPPN group (P = 0.565). Conclusion: Three-in-one admixture may be an easier and faster way that can be used for a short period of nutrient supply in hospitalized children who cannot take enough nutrients via enteral route, compared to conventional PPN method. Disclosure of Interest: None Declared
PP205-SUN CATHETER MANAGEMENT IN HPN PATIENTS WITH CATHETER RELATED BLOOD STREAM INFECTION (CRBSI) K. Majewska1 , J. Pałuba2 , D. Kociszewska2 , I. Fołtyn3 , R. Adryjanek3 , M. Omidi3 , M. Ławi´ nski1 , M. Pertkiewicz1 . 1 Dept. of General Surgery and Clinical Nutrition, Medical University of Warsaw, 2 Clinical Bacteriology, 3 General Surgery and Clinical Nutrition, W. Orlowski, Medical University of Warsaw, Warsaw, Poland Rationale: Treatment for CRBSI should include systemic antibiotic therapy (AT) and catheter management: catheter removal and reinsertion (CRaR) or antibiotic lock therapy (ALT) considered as less efficient. Aim was to compare treatment efficacy of CRaR vs ethanol/ALT (EALT). Methods: Time of failure-free catheter usage, to CRBSI recurrence (IR) and survival of 331 CRBSI in 181 patients, 231 treated by CRaR and 100 by EALT was analysed by KaplanMeier with Cox-Mantel (C-M) test and t-test (T). IR rate with the same strains after EALT or CRaR was compared by chi2 .
Poster presentations For identification of IR associated factors logistic regression was performed. Results: Mean time of catheter usage until next infection, death or HPN weaning was 436±436 days after EALT and 468±441 after CRaR. (T p = 0.29; C-M p = 0.29). In Gram+ plus infections 465±464 days in EALT and 492±467 in CRaR (T p = 0.34;C-M p = 0.85); in Gram-minus 342±332 and 445±425 days (T p = 0.13; C-M p = 0.2). After St. epidermidis CRBSI catheter usage was 400±399 days in EALT and 439±545 in CRaR (T p = 0.67;C-M p = 0.16) and after other ConS 608±562 days and 443±395, respectively (T p = 0.16;C-M p = 0.14). IR caused by the same species of microbes were found in 33 patients; in 17 (17%) EALT and 16 (6.93%) CRaR (chi2 p < 001), most caused by ConS and late. IR until 120 days was observed in 5 (2.2%) CRaR and 7 (7%) EALT (chi2 p = 0.66). In patients without AT IR was 25% ( RR 3.29, p < 0.0005), with delayed targeted mono AT 11.2% (RR 2.7, p < 0.03) and 4.3% in early empiric AT. Only significant factor for IR was lack of AT. Mean time of HPN from the first CRBSI in 48 EALT patients was 1053±748 days and in 133 CRaR 952±709 (T p = 0.62). Survival time wasn’t influenced by number of CRBSI. Conclusion: CRaR and EALT are equally efficient but AT is needed, also when peripheral blood culture is negative. Early aggressive AT therapy diminish IR. Disclosure of Interest: K. Majewska: None Declared, J. Pałuba: None Declared, D. Kociszewska: None Declared, I. Fołtyn: None Declared, R. Adryjanek: None Declared, M. Omidi: None Declared, M. Ławi´ nski: None Declared, M. Pertkiewicz Grant/Research Support: Nutricia, Consultant for: NPS/Nycomed, Speakers bureau of: Baxter, BBraun, MSD, Pfizer
PP206-SUN LONGITUDINAL ASSESSMENT OF PATIENT’S KNOWLEDGE AND RECOGNITION OF CENTRAL VENOUS CATHETER COMPLICATIONS IN HOME PARENTERAL NUTRITION M. Small1 , S. Gabe1 . 1 Clinical Nutrition, St Mark’s Hospital, Harrow, United Kingdom Rationale: Correct and early recognition of central venous catheter (CVC) related complications is vital in self caring home parenteral nutrition (HPN) patients. This study aimed to assess patient’s knowledge of complications over time, to see if high scores were associated with accuracy in detecting problems, and if the method of assessment affected scores. Methods: Patients attending clinic completed a quiz covering knowledge of catheter related bloodstream infection (CRBSI), local infection, occlusion and thrombosis. The quiz was repeated annually. In year 1 and 2 the quiz had open format questions, with patients listing possible symptoms. This was changed in year 3 to closed format questions with multiple choice answers. Complications during the 3 years were recorded. Results: Data was obtained from 12 patients mean age 47(26 73) years. Median time on HPN 7 (4 22) years. Mean year 1 scores 72% (56 88). Mean year 2 scores 79% (30 96). The difference was not significant P = 0.1. Mean year 3 scores 89% (67 100). Year 2 to 3 difference was significant P = 0.02. 6 (50%) patients scored higher each year, 8 (67%) improved between year 1 and 2, and 10 (83%) between year 2 and 3. There were 36 complications, mean 3 (1 8) per patient. CRBSI accounted for 18 (50%), local infection 7 (19%), occlusion 2 (6%), and fracture 9 (25%). Complications were correctly
PP205-SUN CATHETER MANAGEMENT IN HPN PATIENTS WITH CATHETER RELATED BLOOD STREAM INFECTION (CRBSI) K. Majewska1 , J. Pałuba2 , D. Kociszewska2 , I. Fołtyn3 , R. Adryjanek3 , M. Omidi3 , M. Ławi´ nski1 , M. Pertkiewicz1 . 1 Dept. of General Surgery and Clinical Nutrition, Medical University of Warsaw, 2 Clinical Bacteriology, 3 General Surgery and Clinical Nutrition, W. Orlowski, Medical University of Warsaw, Warsaw, Poland Rationale: Treatment for CRBSI should include systemic antibiotic therapy (AT) and catheter management: catheter removal and reinsertion (CRaR) or antibiotic lock therapy (ALT) considered as less efficient. Aim was to compare treatment efficacy of CRaR vs ethanol/ALT (EALT). Methods: Time of failure-free catheter usage, to CRBSI recurrence (IR) and survival of 331 CRBSI in 181 patients, 231 treated by CRaR and 100 by EALT was analysed by KaplanMeier with Cox-Mantel (C-M) test and t-test (T). IR rate with the same strains after EALT or CRaR was compared by chi2 .
Poster presentations For identification of IR associated factors logistic regression was performed. Results: Mean time of catheter usage until next infection, death or HPN weaning was 436±436 days after EALT and 468±441 after CRaR. (T p = 0.29; C-M p = 0.29). In Gram+ plus infections 465±464 days in EALT and 492±467 in CRaR (T p = 0.34;C-M p = 0.85); in Gram-minus 342±332 and 445±425 days (T p = 0.13; C-M p = 0.2). After St. epidermidis CRBSI catheter usage was 400±399 days in EALT and 439±545 in CRaR (T p = 0.67;C-M p = 0.16) and after other ConS 608±562 days and 443±395, respectively (T p = 0.16;C-M p = 0.14). IR caused by the same species of microbes were found in 33 patients; in 17 (17%) EALT and 16 (6.93%) CRaR (chi2 p < 001), most caused by ConS and late. IR until 120 days was observed in 5 (2.2%) CRaR and 7 (7%) EALT (chi2 p = 0.66). In patients without AT IR was 25% ( RR 3.29, p < 0.0005), with delayed targeted mono AT 11.2% (RR 2.7, p < 0.03) and 4.3% in early empiric AT. Only significant factor for IR was lack of AT. Mean time of HPN from the first CRBSI in 48 EALT patients was 1053±748 days and in 133 CRaR 952±709 (T p = 0.62). Survival time wasn’t influenced by number of CRBSI. Conclusion: CRaR and EALT are equally efficient but AT is needed, also when peripheral blood culture is negative. Early aggressive AT therapy diminish IR. Disclosure of Interest: K. Majewska: None Declared, J. Pałuba: None Declared, D. Kociszewska: None Declared, I. Fołtyn: None Declared, R. Adryjanek: None Declared, M. Omidi: None Declared, M. Ławi´ nski: None Declared, M. Pertkiewicz Grant/Research Support: Nutricia, Consultant for: NPS/Nycomed, Speakers bureau of: Baxter, BBraun, MSD, Pfizer
PP206-SUN LONGITUDINAL ASSESSMENT OF PATIENT’S KNOWLEDGE AND RECOGNITION OF CENTRAL VENOUS CATHETER COMPLICATIONS IN HOME PARENTERAL NUTRITION M. Small1 , S. Gabe1 . 1 Clinical Nutrition, St Mark’s Hospital, Harrow, United Kingdom Rationale: Correct and early recognition of central venous catheter (CVC) related complications is vital in self caring home parenteral nutrition (HPN) patients. This study aimed to assess patient’s knowledge of complications over time, to see if high scores were associated with accuracy in detecting problems, and if the method of assessment affected scores. Methods: Patients attending clinic completed a quiz covering knowledge of catheter related bloodstream infection (CRBSI), local infection, occlusion and thrombosis. The quiz was repeated annually. In year 1 and 2 the quiz had open format questions, with patients listing possible symptoms. This was changed in year 3 to closed format questions with multiple choice answers. Complications during the 3 years were recorded. Results: Data was obtained from 12 patients mean age 47(26 73) years. Median time on HPN 7 (4 22) years. Mean year 1 scores 72% (56 88). Mean year 2 scores 79% (30 96). The difference was not significant P = 0.1. Mean year 3 scores 89% (67 100). Year 2 to 3 difference was significant P = 0.02. 6 (50%) patients scored higher each year, 8 (67%) improved between year 1 and 2, and 10 (83%) between year 2 and 3. There were 36 complications, mean 3 (1 8) per patient. CRBSI accounted for 18 (50%), local infection 7 (19%), occlusion 2 (6%), and fracture 9 (25%). Complications were correctly