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.

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

Date of preparation: May 2020 C-ANPROM/INT//7387