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Route of pediatric parenteral nutrition: proposed criteria revision
Insights
Parenteral nutrition in children showed similar complication rates per day for both peripheral and central vein infusions. Caloric needs, not access type, should guide pediatric nutritional support decisions.
Area of Science:
- Pediatric Nutrition
- Clinical Nutrition
- Medical Technology
Background:
- Parenteral nutrition (PN) is crucial for pediatric patients unable to receive adequate nutrition orally.
- Evaluating the efficacy and safety of different PN administration routes is essential for optimizing patient outcomes.
Purpose of the Study:
- To review the experience of parenteral nutrition administration in pediatric patients.
- To compare the outcomes and complication rates between peripheral and central vein infusions.
- To determine the optimal method for nutritional support in children.
Main Methods:
- Retrospective review of 585 pediatric patients receiving PN over 13 months.
- Categorization of PN administration into peripheral vein infusion (385 patients) and central vein infusion (200 patients).
- Analysis of weight gain, duration of therapy, caloric intake, and complication rates (infectious, metabolic, soft tissue sloughs).
Main Results:
- Weight gain observed in 63% of peripheral and 82.5% of central vein recipients.
- Central vein recipients had longer therapy duration and higher caloric intake.
- Overall complication rate was 9.08% for peripheral and 20% for central vein, but per diem rates were similar, with peripheral vein having slightly higher rates.
- Percutaneous subclavian vein catheterization was a safe method for central venous access.
Conclusions:
- The choice of nutritional support in pediatric patients should primarily be based on individual caloric requirements.
- Both peripheral and central vein parenteral nutrition can be effective, but careful monitoring for complications is necessary.
- Vascular access techniques, such as percutaneous subclavian vein catheterization, are safe and facilitate repeated central venous access.
Abstract:
This study reviews the experience of the Nutrition Support Service at the Children's Hospital of Philadelphia over a 13-mo period from 1977 to 1979. Parenteral nutrition was administered to 585 children, 385 by peripheral vein infusion and 200 by central vein infusion. Weight gain was seen in 63% of those patients receiving peripheral vein infusions and 82.5% of those receiving central vein nutrients, and this apparent difference is likely due to the longer duration of therapy in the central vein recipients (33.7 versus 11.4 mean days) and the greater caloric intake delivered to these same patients (128 Kcal/kg/day versus 63.2 Kcal/kg/day). The complication rates were calculated for the more than 11,000 patient days of therapy surveyed; 35 of the 385 peripheral vein patients developed complications, the primary type being solution administration soft tissue sloughs. This amounted to an incidence of 9.08%. Central vein patients in 40 circumstances likewise had complications, 21 being infectious and 12 being metabolic. This accounted for 20% of all central vein recipients, a difference from the peripheral vein group significant to a p value of less than .01. However, when total days of therapy are considered in this complication incidence, a per diem complication rate between these two groups is not different, and in fact, is somewhat worse for the peripheral vein nutrient recipients. Vascular access in this group of patients was via peripheral vein cannulation or via central venous catheter placement, the latter more recenty done exclusively by percutaneous subclavian vein catheter insertions. This technique was safe and allowed repeated access to the central venous system. These data suggest that the only legitimate determining factor for selecting proper nutritional support of the pediatric patient is the caloric need of the individual.