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Long term home parenteral nutrition using a subcutaneous venous access
E Näslund1, C Wadström, L Backman
1Department of Surgery, Karolinska Institute, Danderyds Hospital, 182 88 Danderyd, Sweden.
Clinical Nutrition (Edinburgh, Scotland)
|April 1, 1992
Summary
Home parenteral nutrition (HPN) using port-a-cath systems can be improved. Modifying infusion schedules and using alcohol flushes significantly increases the patency of these vital infusion systems for patients with nonfunctioning bowels.
Area of Science:
- Gastroenterology
- Clinical Nutrition
- Medical Devices
Background:
- Home parenteral nutrition (HPN) is crucial for patients with nonfunctioning bowels.
- Subcutaneous venous access (SVA) infusion systems, like port-a-cath (PAC), enable HPN but are prone to occlusion.
- Occlusion necessitates catheter/port changes, disrupting patient care.
Purpose of the Study:
- To evaluate strategies for improving the patency of SVA infusion systems used for HPN.
- To reduce the frequency of catheter/port occlusions in patients requiring long-term HPN.
Main Methods:
- A case study of a patient with scleroderma-related bowel pseudo-obstruction on HPN for 1192 days.
- Modification of the HPN infusion regimen, including daily carbohydrates/proteins and twice-weekly lipids.
- Implementation of a 2ml 45% alcohol flush protocol in two additional patients.
Main Results:
- Initial HPN regimen in one patient resulted in 6 occlusions over 1192 days.
- Modified infusion schedule (daily carbs/protein, twice-weekly lipids) improved infusion system patency.
- The addition of a 45% alcohol flush protocol in two patients led to 924 consecutive days without occlusions.
Conclusions:
- Optimizing HPN infusion schedules can enhance the longevity of SVA devices.
- A 45% alcohol flush protocol is a highly effective method for preventing SVA occlusion in HPN patients.
- These strategies improve the reliability and reduce complications associated with long-term HPN therapy.
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