PARENTERAL SUPPORT
Long-term parenteral support (PS; PN/IV) is used in patients who are unable to absorb enough nutrients and fluids with oral intake, such as in the case of short bowel syndrome with intestinal failure (SBS-IF).1,2
Unlike enteral feeding, PS directly provides nutrients and fluids intravenously, bypassing the normal process of food absorption and digestion.1,2
PS is a vital method of nutritional support as it helps to keep SBS-IF patients alive.2 PS can be administered in hospital or at home (home parenteral nutrition; HPN). HPN is available in some countries.
ROUTES OF ADMINSTRATION
- Short- to medium-term PS use
The peripherally inserted central catheter (PICC) is recommended for short-/medium-term use.3 - Long-term PS use
The Hickman catheter, the Broviac catheter, or implanted ports are mostly used to provide long-term PS for SBS-IF patients.3
Figure 3. Recommended routes of administration for short- to medium-term PS use and for long-term PS use.
- Jeppesen PB. J Parenter Enteral Nutr. 2014;38(1 Suppl):8S–13S.
- Kelly DG, et al. J Parenter Enteral Nutr. 2014;38(4):427–37.
- Pittiruti et al. Clin Nutr. 2009; 28 (4):365–77.
PARENTERAL SUPPORT COMPLICATIONS AND LIMITATIONS
While parenteral support (PS; PN/IV) is a life-saving therapy for SBS-IF patients, its long-term use is associated with serious complications and limitations.1–4
REDUCED PATIENT QUALITY OF LIFE3
MORBIDITY AND COMPLICATIONS3
LARGE COSTS TO HEALTHCARE SYSTEMS4
Long-term PS limits the freedom of SBS-IF patients by interfering with their sleep, capacity to work, travel and ability to maintain a social life.2,5
Patients who are unable to wean off PS within 2 years following their last intestinal resection may have to be sustained on this therapy for life.6
For SBS-IF patients, this means having to be connected to PS by vein for 12 hours a day, 5–7 times per week.7
SBS-IF COMPLICATIONS ASSOCIATED WITH PS1–4
ALTERED INTESTINAL ANATOMY-RELATED
Bacterial overgrowth
Metabolic bone disease
Renal dysfunction
PS COMPOSITION-RELATED
Hepatobiliary disease
Trace element and/or vitamin deficiencies
Manganese toxicity
CATHETER-ASSOCIATED
Infections
Occlusions
Central vein thrombosis
Figure 4. The use of parenteral support (PS; PN/IV) in SBS-IF is associated with multiple complications.
In addition, treatment with PS can lead to complications, such as catheter-associated infections, sepsis, renal dysfunction and liver failure.1–4,8
Catheter-related infections are the most common complication associated with the use of PS, accounting for 61% of SBS-IF patient hospitalisations.1,8
Complications due to parenteral support accounts for half of SBS-IF patient hospitalisation, with one study showing that within a 12-month period
hospitalised patients spent on average 23 days in hospital.8
- Hofstetter S, et al. Curr Med Res Opin. 2013;29(5):495–504.
- Kelly DG, et al. J Parenter Enteral Nutr. 2014;38(4):427–37.
- Jeppesen PB. J Parenter Enteral Nutr. 2014 May;38(1 Suppl):8S–13S.
- Buchman AL. Dig Dis Sci. 2001;46(1):1–18.
- Smith CE. J Parenter Enteral Nutr. 1993;17(6):501–6.
- Messing B, et al. Gastroenterology. 1999;117(5):1043–50.
- Stubblefield H. Parenteral Nutrition. Accessed from: https://www.healthline.com/health/parenteral-nutrition. Date accessed: April 2020.
- Van Gossum A, et al. Clin Nutr. 2001;20(3):205–10.
- Hofstetter S, et al. Curr Med Res Opin. 2013;29(5):495–504.
- Kelly DG, et al. J Parenter Enteral Nutr. 2014;38(4):427–37.
- Jeppesen PB. J Parenter Enteral Nutr. 2014 May;38(1 Suppl):8S–13S.
- Buchman AL. Dig Dis Sci. 2001;46(1):1–18.
- Smith CE. J Parenter Enteral Nutr. 1993;17(6):501–6.
- Messing B, et al. Gastroenterology. 1999;117(5):1043–50.
- Stubblefield H. Parenteral Nutrition. Accessed from: https://www.healthline.com/health/parenteral-nutrition. Date accessed: April 2020.
- Van Gossum A, et al. Clin Nutr. 2001;20(3):205–10.
Date of preparation: May 2020 C-ANPROM/INT//7387