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PPN in a regional hospital
Nurrition
Vol.
12, No. 718, 1996
SelectedAbstracts from the 20th Annual Scientific Meeting of Australian Society for Parenteraland Enteral Nutrition (AL&PEN) Thursday,19 Octoberto Saturday,21 October1995 Darling Harbour Sydney,Australia
n ABSTRACTS FOR ORAL PRESENTATION
PaINA
Nerrilyn Redcliffe
D a, Hospital,
Dr Jennifer Redcliffe.
Merrily Redcliffe
M Parslow
Queensland
4020
Peripheral PN (PPN) is Often overlooked as of central PN (CPN), as lower osmolasiry lower protein and energy) Solutions must be only limited periods Of time due to thrombophlebitis. This paper describes the Redcliffe Hospital.
4020.
I" a 12 month period 12 patients were fed (or attempted fS be) into the jejunum. Diagnoses included surgery for IJ~pRlZ gastrointestinal malignancy or obstruction, pancreatic fistula, pancrea:itiS and biliary peritonitis. Tube placements were: nSsojejunS1 tube placed during operation/procedure - 9; jejunontomy during operation - 2; r.asojej.xnal tube placed by Radiologist - 2 lthe same patient twice); resite surgically placed nasojejunal tube by Radiologist - 1. Feeding was commenced mostly by day 2 o" 20-3Oml/hr Vital or Alitcaq. Goal rStes were achieved i?. 2-3 dSys. Total days of feeding were: 1esS than 5 days - 6: S-13 days - 4; 21-31 days - 3. Problems encountered included: 1 case - vomit and tube dislodged; 3 cSses - tube s:iFped out; 2 cSses - tube removed too eSrly; 1 case feed back up nasogastric tube; 1 CBSC - feed leaked oui drain site; 2 caseS with jejunostomies had persistently large nasog.stric SspirStes (?cause).
Of 66 case.5 of parentera: nucricion in 12 months, 21 were PPN. I" i3 cases PPN %a8 adni?.istcred for S-10 days and ceased as EC longer required. In 8 cases PPN was administered for 3 .days or less, wi:h 4 of these ceasing due to phlebitis. Phlebitis occursed only when administration protocols were not sirictly adhered to. 1n 7 cases CPN was also received, a-d ??N used either prior to or with the removal of the ce"trSi line eg. Sepsis.
reserved.
I4 PSrslow Queensland,
Information and evidence on early enteral feeding and uSe of jejunal feeding to Schieve this WBS provided to surgical and anaesthetic staff urd followed up by tube placement during operation. discussions regarding Radiologists agreed to place nasojejunal tubes when required eg. for gastroparesis.
A premix solution of SynchSmi" 13/Cextrose 2Ok with electrolytes and trace elearnts is used (osmolarity = 1lOOnOsm). A maximum of 2 lit.reS daily iS administered, and with 500ml of 20% Intralipid provides 809 protein and 7400Kj. To reduce the risk of phlebitis the Intralipid is run continuously with the premix over 24 hours, hydrocortisone (30&l) and heparin (lOOOUnits/l) are added to the premix, and a transiderm Cm-ate patch (25mg) is placed over the IV site. IV sites Sre routinely changed every two to maximum three days. PPN is used when parenteral nutri:ion is required but a central line is undesirable. Maximum time on PPS is about 10 days.
Nutrition 12:573-579, 1996 OElsevier Science Inc. 1996 Printed in the USA. All rights
Dr Jennifer Redcliffe,
Jejunal feeding is now frequently recommended to achieve nutrition. the benefits of early enteral This PaPer discusses the actions taken to influence the use of jejune1 feeding, and the experiences encountered St Redcliffe Hospital.
a poor cousin (and therefore used, and for the risk of use of PPN St
Conclusion: PPN is a SuitdDle S'---•rnative to CPN in short term. It can make S significant contribution nutritional input when a central line is undesirable.
D Ban& Hospital,
the to
Conclusion: Half the patients trialled were successfully fed jS;unally in that enteral nutrition Support wSS mal"cained without or with reduced use of parentera nutrition. The others were fed for too short a period due to tube dislodgment or removal to make eny conclusions. tube dislodgement WSS the most common problem.
ELSEVIER
0899-9007/96/$15.00
Vol.
12, No. 718, 1996
SelectedAbstracts from the 20th Annual Scientific Meeting of Australian Society for Parenteraland Enteral Nutrition (AL&PEN) Thursday,19 Octoberto Saturday,21 October1995 Darling Harbour Sydney,Australia
n ABSTRACTS FOR ORAL PRESENTATION
PaINA
Nerrilyn Redcliffe
D a, Hospital,
Dr Jennifer Redcliffe.
Merrily Redcliffe
M Parslow
Queensland
4020
Peripheral PN (PPN) is Often overlooked as of central PN (CPN), as lower osmolasiry lower protein and energy) Solutions must be only limited periods Of time due to thrombophlebitis. This paper describes the Redcliffe Hospital.
4020.
I" a 12 month period 12 patients were fed (or attempted fS be) into the jejunum. Diagnoses included surgery for IJ~pRlZ gastrointestinal malignancy or obstruction, pancreatic fistula, pancrea:itiS and biliary peritonitis. Tube placements were: nSsojejunS1 tube placed during operation/procedure - 9; jejunontomy during operation - 2; r.asojej.xnal tube placed by Radiologist - 2 lthe same patient twice); resite surgically placed nasojejunal tube by Radiologist - 1. Feeding was commenced mostly by day 2 o" 20-3Oml/hr Vital or Alitcaq. Goal rStes were achieved i?. 2-3 dSys. Total days of feeding were: 1esS than 5 days - 6: S-13 days - 4; 21-31 days - 3. Problems encountered included: 1 case - vomit and tube dislodged; 3 cSses - tube s:iFped out; 2 cSses - tube removed too eSrly; 1 case feed back up nasogastric tube; 1 CBSC - feed leaked oui drain site; 2 caseS with jejunostomies had persistently large nasog.stric SspirStes (?cause).
Of 66 case.5 of parentera: nucricion in 12 months, 21 were PPN. I" i3 cases PPN %a8 adni?.istcred for S-10 days and ceased as EC longer required. In 8 cases PPN was administered for 3 .days or less, wi:h 4 of these ceasing due to phlebitis. Phlebitis occursed only when administration protocols were not sirictly adhered to. 1n 7 cases CPN was also received, a-d ??N used either prior to or with the removal of the ce"trSi line eg. Sepsis.
reserved.
I4 PSrslow Queensland,
Information and evidence on early enteral feeding and uSe of jejunal feeding to Schieve this WBS provided to surgical and anaesthetic staff urd followed up by tube placement during operation. discussions regarding Radiologists agreed to place nasojejunal tubes when required eg. for gastroparesis.
A premix solution of SynchSmi" 13/Cextrose 2Ok with electrolytes and trace elearnts is used (osmolarity = 1lOOnOsm). A maximum of 2 lit.reS daily iS administered, and with 500ml of 20% Intralipid provides 809 protein and 7400Kj. To reduce the risk of phlebitis the Intralipid is run continuously with the premix over 24 hours, hydrocortisone (30&l) and heparin (lOOOUnits/l) are added to the premix, and a transiderm Cm-ate patch (25mg) is placed over the IV site. IV sites Sre routinely changed every two to maximum three days. PPN is used when parenteral nutri:ion is required but a central line is undesirable. Maximum time on PPS is about 10 days.
Nutrition 12:573-579, 1996 OElsevier Science Inc. 1996 Printed in the USA. All rights
Dr Jennifer Redcliffe,
Jejunal feeding is now frequently recommended to achieve nutrition. the benefits of early enteral This PaPer discusses the actions taken to influence the use of jejune1 feeding, and the experiences encountered St Redcliffe Hospital.
a poor cousin (and therefore used, and for the risk of use of PPN St
Conclusion: PPN is a SuitdDle S'---•rnative to CPN in short term. It can make S significant contribution nutritional input when a central line is undesirable.
D Ban& Hospital,
the to
Conclusion: Half the patients trialled were successfully fed jS;unally in that enteral nutrition Support wSS mal"cained without or with reduced use of parentera nutrition. The others were fed for too short a period due to tube dislodgment or removal to make eny conclusions. tube dislodgement WSS the most common problem.
ELSEVIER
0899-9007/96/$15.00