Parenteral Support

Long-term parenteral support is used in patients who are unable to absorb sufficient nutrients and fluids with oral intake.1–3

Parenteral support is a vital method of nutritional support4Illustrator of PN/IV support

  • It provides patients with all of their unmet fluid, nutritional and electrolyte needs intravenously1–3
    • This is done by bypassing the normal process of food absorption and digestion (Figure 2).1–3
  • It is started immediately after the intestine has been surgically removed for prompt care of these patients1,3
  • It helps to compensate for the reduction in intestinal absorption of the contents of a normal diet1,3 
  • It reduces the risk of dehydration and malnutrition1,3
  • It can be gradually decreased over time in some patients, reducing their dependency on it
    • A few patients may even eventually be weaned off parenteral support altogether.1,4

 

Over time, some patients can gradually
decrease dependence on parenteral support,
and a few may even eventually be weaned off
parenteral support altogether1,4

 

Complications associated with parenteral support

Long-term parenteral nutrition is a life-saving support therapy in those patients with SBS with intestinal failure, which can be associated with complications.4

  • Potential complications, some of which might be life-threatening, include:1,5–8 
    • Catheter-related complications, e.g. infection, thrombosis
    • Liver disease, e.g. cirrhosis
    • Biliary dysfunction, e.g. gallstones
    • Metabolic bone disease, e.g. osteoporosis

The impact of parenteral support on quality of life

  • Parenteral support can also have an impact on important elements of patients' quality of life, for example:
    • Feelings of guilt through being a burden on others9,10
    • Fatigue and weakness5,9,10
    • Depression5,9–11
    • Interrupted sleep (due to the long infusions, which are typically administered overnight, and to frequent bathroom visits)5,9–11
    • Limited mobility during infusions5,10
    • Reduced sexual drive and function5,9,10
    • Inability to work or maintain employment5,9–11
    • Disruption of patients ability to: travel, take part in leisure activities and enjoy a full social life5,9–11

The importance of good hygiene practices

It is also important that patients are aware of the value of good hygiene practices while receiving parenteral nutrition. A study investigating parenteral nutrition catheterisation reported that poor patient hygiene was a risk factor for catheter-related bloodstream infections, and that particular attention should be paid to hand cleanliness.12

importance of good hygiene practices

As part of good general hygiene practices, it is also important that patients continue to regularly brush their teeth and use mouthwashes even if they are unable to eat or drink anything. This is because plaque can quickly accumulate, especially in dry mouth conditions. Despite similar levels of oral hygiene, patients receiving parenteral nutrition have been shown to suffer from general poorer dental health than the normal population, with greater levels of tooth decay, fewer teeth and fewer healthy teeth.13

 

References

  1. Jeppesen PB. Spectrum of short bowel syndrome in adults: intestinal insufficiency to intestinal failure. JPEN J Parenter Enteral Nutr 2014;38(1 Suppl):8S–13S.
  2. O'Keefe SJ, Buchman AL, Fishbein TM, et al. Short bowel syndrome and intestinal failure: consensus definitions and overview. Clin Gastroenterol Hepatol 2006;4(1):6–10.
  3. Buchman AL, Scolapio J, Fryer J. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology 2003;124(4):1111–34.
  4. Matarese LE. Nutrition and fluid optimization for patients with short bowel syndrome. JPEN J Parenter Enteral Nutr 2013;37(2):161-70.
  5. Hofstetter S, Stern L, Willet J. Key issues in addressing the clinical and humanistic burden of short bowel syndrome in the US. Curr Med Res Opin 2013;29(5):495–504.
  6. Mullady DK, O'Keefe SJ. Treatment of intestinal failure: home parenteral nutrition. Nat Clin Pract Gastroenterol Hepatol 2006;3(9):492-504
  7. Donohoe CL, Reynolds JV. Short bowel syndrome. Surgeon 2010;8(5):270–9.
  8. Misiakos EP, Macheras A, Kapetanakis T, Liakakos T. Short bowel syndrome: current medical and surgical trends. J Clin Gastroenterol 2007;41(1):5–18.
  9. Huisman-de Waal G, Schoonhoven L, Jansen J, Wanten G, van Achterberg T. The impact of home parenteral nutrition on daily life: a review. Clin Nutr 2007;26(3):275–88.
  10. Kelly DG, Tappenden KA, Winkler MF. Short bowel syndrome: highlights of patient management, quality of life, and survival. JPEN J Parenter Enteral Nutr 2014;38(4):427–37.
  11. Winkler MF, Smith CE. Clinical, social, and economic impacts of home parenteral nutrition dependence in short bowel syndrome. JPEN J Parenter Enteral Nutr 2014 May;38(1 Suppl):32S–7S.
  12. Yilmaz G, Koksal I, Aydin K, Caylan R, Sucu N, Aksoy F. Risk factors of catheter-related bloodstream infections in parenteral nutrition catheterization. JPEN J Parenter Enteral Nutr 2007;31(4):284–87.
  13. Lee AM, Gabe SM, Nightingale JM, Burke M. Intestinal failure and home parenteral nutrition: implications for oral health and dental care. Clin Nutr 2013;32(1):77–82.

     

     

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