- Email: [email protected]
SUN-PP262: Nasogastric Tube Blockage: Does Bacteria Play a Role?
S120 We registered: NEX, length advised by the Dutch guideline and actual inserted length. Nurses were asked to insert NGTs according to the hospital guideline and to advance the tube only when no aspirate was obtained, until aspirate was obtained. Results: 108 NGTs in 92 patients were registered (54% female, age 72±13 years). 84 NGTs (78%) were inserted deeper than the guideline prescribed, all other NGTs were inserted until the length according to the guideline. On average tubes were inserted 5.52 cm deeper: Mean actual inserted length (n = 108): 56.85 cm. Mean NEX (n = 108): 54.21 cm. Mean length according to guideline (n = 108): 51.33 cm. Mean difference actual vs. NEX (n = 108): 2.64 cm (4.9% deeper). Mean difference actual vs. Dutch guideline (n = 108): 5.52 cm (10.7% deeper). Conclusion: On average NGTs had to be inserted 5.52 cm deeper (10.7%) than prescribed in the Dutch guideline in order to be able to obtain aspirate. This indicates that the Dutch guideline seems to underestimate the actual length of NGTs that is needed to aspirate gastric content. Disclosure of Interest: None declared
SUN-PP260 PROTEIN, LIPID, CARBOHYDRATE ENERGY PERCENTAGE IN JAPANESE HOSPITAL’S ORDINARY MEAL M. Hasegawa1 , M. Shiga2 . 1 Physician, 2 Dietitian, Kariya Toyota General Hospital Takahama Branch, Takahama, Japan Rationale: Every trophotherapy is the base of medical treatment. At the museum in Vivi, it is said Ideally protein ratio 15%, lipids 30% . . . , Actually protein ratio 13%, lipids 39% . . . . We want to know ratio of nutrient in ordinary meal in hospital. Methods: We surveyed using questionnaire total energy, protein, lipids, carbohydrate on November 5th 2012. And obtain 162 data (type: acute care setting 96, rehabilitation setting 38, Nursing home etc. 28) (region: East Japan 50, Central Japan 46, West Japan 66). Results: Total energy 1784±160 kcal, protein 67.6±6.9 g, lipids 43.9±6.8 g, carbohydrate 273±33 g, NPC/N 138.2±15.5. total energy correlate with protein r = 0.538 (p = 1.50E-13), lipids r = 0.366 (p = 1.69E-6), carbohydrate r = 0.889 (p = 3.76E-56), NPC/N r = 0.340 (p = 9.73E-6). Protein energy ratio 15.2±1.4%. Lipids energy ratio 22.2±3.3%. Carbohydrate energy ratio 61.0±3.7%. Dividing on type lesion, there are big differences in total energy. But there are no differences in nutrient ratio. Carbohydrate energy ratio correlate with protein energy ratio r = 0.275 (p = 4.35E-4), lipid energy ratio r = 0.829 (p = 8.34E-42). Total energy is mainly adjusted by carbohydrate. Nutrient ratios are almost homogeneous. Carbohydrate and lipid are interchangeable. Conclusion: Protein energy ratio 15.2±1.4%, lipids 22.2±3.3%, carbohydrate 61.0±3.7%. The NPC/N of ordinary meal is 138.3±15.5 in Japanese Hospital. So ideal NPC/N is around 138 in Japan. We must compare this figure to that of Parenteral Nutrition or Enteral Nutrition. Disclosure of Interest: None declared
Poster presentations SUN-PP261 LONG TERM SUBCUTANEOUS SALINE AND MAGNESIUM ADMINISTRATION IN PATIENTS WITH A SHORT BOWEL 10 YEAR OUTCOMES M. Small1 , D. Brundrett2 , J. Nightingale1 . 1 Clinical Nutrition, 2 Nutrition and Dietetics, St Mark’s Hospital, Harrow, United Kingdom Rationale: Subcutaneous sodium & magnesium is a treatment for patients with a short bowel and adequate nutritional status, but with sodium & magnesium depletion. This study aimed to describe long-term outcomes of patients treated with subcutaneous fluid (SCF). Methods: 10 year review of records. All patients had an inpatient assessment where bowel function was optimised and SCF established. Patients were taught to gravity infuse via a 22 Gauge plastic cannula in the subcutaneous tissue of the upper leg/abdomen. Results: 32 patients (22F, 10M) were identified. Mean BMI 24±4.8 (18 41). Mean time on SCF 20±31 (0.5 139) months. Underlying condition Crohn’s/ulcerative colitis (n = 14), surgical complications (n = 9), mesenteric infarction (n = 5), other (n = 4). Mean infusion volume was 4±2.1 (0.5 7) litre/week. Mean sodium 671±331 (77 1078) mmol/week. 5 (16%) patients had <100 cm small bowel to stoma, mean duration 9.4±6.7 (3 18) months. 12 (38%) patients had 100 150 cm small bowel to stoma, mean duration 15.5±20 (2 74) months. 13 (40%) patients had >150 cm small bowel to stoma mean duration 29±44 (0.5 139) months. 2 (6%) patients had small bowel to colon, mean duration 19.5±2.1 (18 21) months. There was no difference between patients with <150 cm small bowel vs those with >150 cm, p = 0.2. 24 (75%) patients had magnesium in their infusions, mean 22.2±11.8 (2 48) mmol per week. Most patients 25 (78%) had no complications. 6 (19%) patients had leaking at the infusion site. Failure of treatment was most commonly due to an infusion taking too long to go in ± fluid leaking (n = 7). In 3 patients it did not correct magnesium, 3 had weight loss requiring parenteral nutrition. 8 stopped after surgery. 3 were transferred. 8 are still on treatment. Conclusion: SCF are well tolerated in patients with a short bowel and sodium & magnesium depletion. Complications are minor and infrequent and some patients can remain on therapy for many years. Disclosure of Interest: None declared
SUN-PP262 NASOGASTRIC TUBE BLOCKAGE: DOES BACTERIA PLAY A ROLE? M. Baker Moffatt1 , S. Green2 , S. Wilks2 . 1 University of Southampton and Portsmouth Hospitals NHS Trust, 2 University of Southampton, Southampton, United Kingdom Rationale: Fine-bore nasogastric tube blockages can result in delays in nutrient provision and poor patient experience. Bacterial colonisation of the internal lumen wall of these tubes has the potential to initiate such blockages, but has been little investigated. Methods: A series of interlinked laboratory studies has been undertaken to provide evidence of bacterial colonisation within nasogastric tubes used by adults. These studies have sought to establish the speed of bacterial attachment to the
Nutritional techniques and formulations
S121
nasogastric tube material, and the effectiveness of flushing to prevent blockages, using both sterile water and tap water. Culturable cells were quantified by colony forming units, and bacterial viability was measured by cell elongation. In addition, sections of inoculated nasogastric feeding tube were examined by microscopy. Results: The findings have shown bacterial colonisation is present within the lumen of nasogastric tubes used by adults. The speed of bacterial attachment can be as little as 15 minutes. There appears to be no notable benefit to flushing nasogastric tubes with sterile water as opposed to tap water. Conclusion: The laboratory studies have demonstrated bacterial colonisation on nasogastric tube lumen walls over a 24 hour period in the laboratory setting. The presence of bacteria in this environment may have the potential to interrupt flow through the lumen and contribute to blockage development. Future studies will look at whether medication and feed regimen have an effect on the extent of bacteria present and the potential rates of occlusion. Disclosure of Interest: None declared
SUN-PP263 ASSESSMENT OF THE ENTERAL NUTRITION PROTOCOL 1,1
1
1
D. Sagban , O. Demirkiran . Anesthesiology and Intensive Care, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey Rationale: We aimed to reveal the factors that may affect the practicability of our enteral nutrition protocol, which we use in the intensive care unit. Methods: Patients over 18 yo, stay >5 days, need mechanical ventilation (MV) support >48 hours, and feed according to the enteral nutrition protocol in ICU were included in this study. Demographic data, ICU admission diagnosis, length of ICU stay and MV days, APACHE II score, use of sedation and inotrope, existence of malignancy, goals and amount of calories, and outcome were recorded. Reasons for not succeeding in the nutrition goal are indicated as excessive gastric residue (>150 mL), feeding tube problems, surgical barriers and diagnostic procedures, unexpected extubation, weaning, mistakes in doctor orders and practice. Results: High APACHE II score, use of inotrope, excessive gastric residue and diagnostic procedures are found as significant risk factors for not achieving the target calorie intake. Table 1. Risk factors
Inotrope use Gastric volume >150 ml Interventions APACHE II
B
P
OR
95% CI (min, max)
1.417 1.914 1.965 0.016
0.002 0.001 0.001 0.559
4.12 6.78 7.13 1.02
1.68 2.98 2.84 0.96
10.09 15.45 17.91 1.07
Conclusion: High APACHE II score, inotrope use and diagnostic procedures of critical patients are determined as risk factors undermining the conformity with the protocol. Gastric residue volume of 150 ml or over determined by our protocol appears to be low compared to ones in up-to-date research and, as shown in our study, an update of a new residue gastric volume of 250 500 ml may have more benefit clinical results. References Dhaliwal R, Cahill N, Lemieux M, Heyland DK, The Canadian critical care nutrition guidelines in 2013: an update on current
recommendations and implementation strategies. Nutr Clin Pract. 2014 Feb; 29(1): 29 43. Disclosure of Interest: None declared
SUN-PP264 CORRELATION BETWEEN THE ESTIMATION METHODS AND ANTHROPOMETRIC MEASUREMENTS OF WEIGHT AND HEIGHT IN A HOSPITALIZED POPULATION IN BRAZILIAN NORTHEAST P.S. Barcellos1 , N.J. Pereira-J´ unior1 , T. Ascen¸ ca ˜o1 . 1 Ciencias Fisiologicas, Universidade Federal Do Maranhao, S˜ ao Luís, Brazil Rationale: Correlate estimation of weight and height methods with anthropometric measurements in hospitalized patients in a Brazilian University Hospital. Methods: A cross-sectional study in 2013 with 82 hospitalized patients of a Brazilian University Hospital. Correlation between weight and height measures related to estimation formulas. Results: See the table. Table: Weight and height measured means and the estimated weight and height according to sex of hospitalized patients of a University Hospital, S˜ ao Luís, 2013 Total
Weight Real Weight Chumlea, 1988 Rabito, 2006 Formula II Rabito, 2006 Formula III Height Real Height Chumlea, 1988 and 1994 Envergadura WHO, 1999
Men (n = 46)
Women (n = 36)
mean
SD
p
mean
SD
p
61.5 65.2 65.7 66.3
63.3 65.0 65.4 66.8
±10.2 ±10.6 ±10.2 ±9.9
<0.001 <0.001 <0.001 <0.001
59.3 65.6 66.0 65.7
±11.7 ±13.9 ±11.5 ±15.0
<0.0001 <0.0001 <0.0001 <0.0001
1.59 1.63 1.65
1.64 1.68 1.69
±0.06 ±0.05 ±0.06
<0.001 <0.001 <0.001
1.52 1.58 1.60
±0.06 ±0.05 ±0.07
<0.0001 <0.0001 <0.0001
Conclusion: Anthropometric measures and estimates methods means have statistic differences. New estimates more suited to clinical practice and population studied, since the weight and height are strong indicators of monitoring and recovery of nutritional status. References Chumlea W.C., et al. Prediction of body weight for the no ambulatory elderly from anthropometry. JADA, v. 88, n. 5, p. 564 568, 1988. Chumlea W.C., et al. Prediction of stature from knee height for black and white adults and children with application to mobilityimpaired or handicapped persons. JADA, v. 94, n. 12, p. 1385 1388, 1994. Rabito E.I., et al. Weight and height prediction of immobilized patients. Revista de Nutri¸ ca ˜o, v. 19, p. 655 661, 2006. World Health Organization (1999). Expert Committee, Physical status: the use and interpretation of anthropometry. Geneva: WHO. Disclosure of Interest: None declared
SUN-PP265 COMPOSITION OF COMPLETE AMINO ACID SOLUTIONS USED IN PARENTERAL NUTRITION R. Iacone1 , C. Scanzano1 , C. Chiurazzi1 , A. D’Isanto1 , E. Pastore1 , F. Pasanisi1 , F. Contaldo1 , L. Santarpia1 . 1 Department of Clinical Medicine and Surgery, “Federico II” University Hospital, Naples, Italy Rationale: Personalized mixtures for parenteral nutrition (PN) include essential and nonessential amino acids. Skeletal muscle mass accretion requires adequate amount of essential
SUN-PP260 PROTEIN, LIPID, CARBOHYDRATE ENERGY PERCENTAGE IN JAPANESE HOSPITAL’S ORDINARY MEAL M. Hasegawa1 , M. Shiga2 . 1 Physician, 2 Dietitian, Kariya Toyota General Hospital Takahama Branch, Takahama, Japan Rationale: Every trophotherapy is the base of medical treatment. At the museum in Vivi, it is said Ideally protein ratio 15%, lipids 30% . . . , Actually protein ratio 13%, lipids 39% . . . . We want to know ratio of nutrient in ordinary meal in hospital. Methods: We surveyed using questionnaire total energy, protein, lipids, carbohydrate on November 5th 2012. And obtain 162 data (type: acute care setting 96, rehabilitation setting 38, Nursing home etc. 28) (region: East Japan 50, Central Japan 46, West Japan 66). Results: Total energy 1784±160 kcal, protein 67.6±6.9 g, lipids 43.9±6.8 g, carbohydrate 273±33 g, NPC/N 138.2±15.5. total energy correlate with protein r = 0.538 (p = 1.50E-13), lipids r = 0.366 (p = 1.69E-6), carbohydrate r = 0.889 (p = 3.76E-56), NPC/N r = 0.340 (p = 9.73E-6). Protein energy ratio 15.2±1.4%. Lipids energy ratio 22.2±3.3%. Carbohydrate energy ratio 61.0±3.7%. Dividing on type lesion, there are big differences in total energy. But there are no differences in nutrient ratio. Carbohydrate energy ratio correlate with protein energy ratio r = 0.275 (p = 4.35E-4), lipid energy ratio r = 0.829 (p = 8.34E-42). Total energy is mainly adjusted by carbohydrate. Nutrient ratios are almost homogeneous. Carbohydrate and lipid are interchangeable. Conclusion: Protein energy ratio 15.2±1.4%, lipids 22.2±3.3%, carbohydrate 61.0±3.7%. The NPC/N of ordinary meal is 138.3±15.5 in Japanese Hospital. So ideal NPC/N is around 138 in Japan. We must compare this figure to that of Parenteral Nutrition or Enteral Nutrition. Disclosure of Interest: None declared
Poster presentations SUN-PP261 LONG TERM SUBCUTANEOUS SALINE AND MAGNESIUM ADMINISTRATION IN PATIENTS WITH A SHORT BOWEL 10 YEAR OUTCOMES M. Small1 , D. Brundrett2 , J. Nightingale1 . 1 Clinical Nutrition, 2 Nutrition and Dietetics, St Mark’s Hospital, Harrow, United Kingdom Rationale: Subcutaneous sodium & magnesium is a treatment for patients with a short bowel and adequate nutritional status, but with sodium & magnesium depletion. This study aimed to describe long-term outcomes of patients treated with subcutaneous fluid (SCF). Methods: 10 year review of records. All patients had an inpatient assessment where bowel function was optimised and SCF established. Patients were taught to gravity infuse via a 22 Gauge plastic cannula in the subcutaneous tissue of the upper leg/abdomen. Results: 32 patients (22F, 10M) were identified. Mean BMI 24±4.8 (18 41). Mean time on SCF 20±31 (0.5 139) months. Underlying condition Crohn’s/ulcerative colitis (n = 14), surgical complications (n = 9), mesenteric infarction (n = 5), other (n = 4). Mean infusion volume was 4±2.1 (0.5 7) litre/week. Mean sodium 671±331 (77 1078) mmol/week. 5 (16%) patients had <100 cm small bowel to stoma, mean duration 9.4±6.7 (3 18) months. 12 (38%) patients had 100 150 cm small bowel to stoma, mean duration 15.5±20 (2 74) months. 13 (40%) patients had >150 cm small bowel to stoma mean duration 29±44 (0.5 139) months. 2 (6%) patients had small bowel to colon, mean duration 19.5±2.1 (18 21) months. There was no difference between patients with <150 cm small bowel vs those with >150 cm, p = 0.2. 24 (75%) patients had magnesium in their infusions, mean 22.2±11.8 (2 48) mmol per week. Most patients 25 (78%) had no complications. 6 (19%) patients had leaking at the infusion site. Failure of treatment was most commonly due to an infusion taking too long to go in ± fluid leaking (n = 7). In 3 patients it did not correct magnesium, 3 had weight loss requiring parenteral nutrition. 8 stopped after surgery. 3 were transferred. 8 are still on treatment. Conclusion: SCF are well tolerated in patients with a short bowel and sodium & magnesium depletion. Complications are minor and infrequent and some patients can remain on therapy for many years. Disclosure of Interest: None declared
SUN-PP262 NASOGASTRIC TUBE BLOCKAGE: DOES BACTERIA PLAY A ROLE? M. Baker Moffatt1 , S. Green2 , S. Wilks2 . 1 University of Southampton and Portsmouth Hospitals NHS Trust, 2 University of Southampton, Southampton, United Kingdom Rationale: Fine-bore nasogastric tube blockages can result in delays in nutrient provision and poor patient experience. Bacterial colonisation of the internal lumen wall of these tubes has the potential to initiate such blockages, but has been little investigated. Methods: A series of interlinked laboratory studies has been undertaken to provide evidence of bacterial colonisation within nasogastric tubes used by adults. These studies have sought to establish the speed of bacterial attachment to the
Nutritional techniques and formulations
S121
nasogastric tube material, and the effectiveness of flushing to prevent blockages, using both sterile water and tap water. Culturable cells were quantified by colony forming units, and bacterial viability was measured by cell elongation. In addition, sections of inoculated nasogastric feeding tube were examined by microscopy. Results: The findings have shown bacterial colonisation is present within the lumen of nasogastric tubes used by adults. The speed of bacterial attachment can be as little as 15 minutes. There appears to be no notable benefit to flushing nasogastric tubes with sterile water as opposed to tap water. Conclusion: The laboratory studies have demonstrated bacterial colonisation on nasogastric tube lumen walls over a 24 hour period in the laboratory setting. The presence of bacteria in this environment may have the potential to interrupt flow through the lumen and contribute to blockage development. Future studies will look at whether medication and feed regimen have an effect on the extent of bacteria present and the potential rates of occlusion. Disclosure of Interest: None declared
SUN-PP263 ASSESSMENT OF THE ENTERAL NUTRITION PROTOCOL 1,1
1
1
D. Sagban , O. Demirkiran . Anesthesiology and Intensive Care, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey Rationale: We aimed to reveal the factors that may affect the practicability of our enteral nutrition protocol, which we use in the intensive care unit. Methods: Patients over 18 yo, stay >5 days, need mechanical ventilation (MV) support >48 hours, and feed according to the enteral nutrition protocol in ICU were included in this study. Demographic data, ICU admission diagnosis, length of ICU stay and MV days, APACHE II score, use of sedation and inotrope, existence of malignancy, goals and amount of calories, and outcome were recorded. Reasons for not succeeding in the nutrition goal are indicated as excessive gastric residue (>150 mL), feeding tube problems, surgical barriers and diagnostic procedures, unexpected extubation, weaning, mistakes in doctor orders and practice. Results: High APACHE II score, use of inotrope, excessive gastric residue and diagnostic procedures are found as significant risk factors for not achieving the target calorie intake. Table 1. Risk factors
Inotrope use Gastric volume >150 ml Interventions APACHE II
B
P
OR
95% CI (min, max)
1.417 1.914 1.965 0.016
0.002 0.001 0.001 0.559
4.12 6.78 7.13 1.02
1.68 2.98 2.84 0.96
10.09 15.45 17.91 1.07
Conclusion: High APACHE II score, inotrope use and diagnostic procedures of critical patients are determined as risk factors undermining the conformity with the protocol. Gastric residue volume of 150 ml or over determined by our protocol appears to be low compared to ones in up-to-date research and, as shown in our study, an update of a new residue gastric volume of 250 500 ml may have more benefit clinical results. References Dhaliwal R, Cahill N, Lemieux M, Heyland DK, The Canadian critical care nutrition guidelines in 2013: an update on current
recommendations and implementation strategies. Nutr Clin Pract. 2014 Feb; 29(1): 29 43. Disclosure of Interest: None declared
SUN-PP264 CORRELATION BETWEEN THE ESTIMATION METHODS AND ANTHROPOMETRIC MEASUREMENTS OF WEIGHT AND HEIGHT IN A HOSPITALIZED POPULATION IN BRAZILIAN NORTHEAST P.S. Barcellos1 , N.J. Pereira-J´ unior1 , T. Ascen¸ ca ˜o1 . 1 Ciencias Fisiologicas, Universidade Federal Do Maranhao, S˜ ao Luís, Brazil Rationale: Correlate estimation of weight and height methods with anthropometric measurements in hospitalized patients in a Brazilian University Hospital. Methods: A cross-sectional study in 2013 with 82 hospitalized patients of a Brazilian University Hospital. Correlation between weight and height measures related to estimation formulas. Results: See the table. Table: Weight and height measured means and the estimated weight and height according to sex of hospitalized patients of a University Hospital, S˜ ao Luís, 2013 Total
Weight Real Weight Chumlea, 1988 Rabito, 2006 Formula II Rabito, 2006 Formula III Height Real Height Chumlea, 1988 and 1994 Envergadura WHO, 1999
Men (n = 46)
Women (n = 36)
mean
SD
p
mean
SD
p
61.5 65.2 65.7 66.3
63.3 65.0 65.4 66.8
±10.2 ±10.6 ±10.2 ±9.9
<0.001 <0.001 <0.001 <0.001
59.3 65.6 66.0 65.7
±11.7 ±13.9 ±11.5 ±15.0
<0.0001 <0.0001 <0.0001 <0.0001
1.59 1.63 1.65
1.64 1.68 1.69
±0.06 ±0.05 ±0.06
<0.001 <0.001 <0.001
1.52 1.58 1.60
±0.06 ±0.05 ±0.07
<0.0001 <0.0001 <0.0001
Conclusion: Anthropometric measures and estimates methods means have statistic differences. New estimates more suited to clinical practice and population studied, since the weight and height are strong indicators of monitoring and recovery of nutritional status. References Chumlea W.C., et al. Prediction of body weight for the no ambulatory elderly from anthropometry. JADA, v. 88, n. 5, p. 564 568, 1988. Chumlea W.C., et al. Prediction of stature from knee height for black and white adults and children with application to mobilityimpaired or handicapped persons. JADA, v. 94, n. 12, p. 1385 1388, 1994. Rabito E.I., et al. Weight and height prediction of immobilized patients. Revista de Nutri¸ ca ˜o, v. 19, p. 655 661, 2006. World Health Organization (1999). Expert Committee, Physical status: the use and interpretation of anthropometry. Geneva: WHO. Disclosure of Interest: None declared
SUN-PP265 COMPOSITION OF COMPLETE AMINO ACID SOLUTIONS USED IN PARENTERAL NUTRITION R. Iacone1 , C. Scanzano1 , C. Chiurazzi1 , A. D’Isanto1 , E. Pastore1 , F. Pasanisi1 , F. Contaldo1 , L. Santarpia1 . 1 Department of Clinical Medicine and Surgery, “Federico II” University Hospital, Naples, Italy Rationale: Personalized mixtures for parenteral nutrition (PN) include essential and nonessential amino acids. Skeletal muscle mass accretion requires adequate amount of essential