Parenteral Requirements For Cancer Patients

Enteral Nutrition Promotes Closure of Post-Op Pancreatic Fistula

Enteral nutrition is superior to total parenteral nutrition for the treatment of grade B postoperative pancreatic fistulas, reported Dr. Stanislaw Klek and his colleagues in the July issue of Gastroenterology.

Indeed, not only does enteral nutrition facilitate fistula closure, but closure occurs more quickly and the enteral approach is less costly, wrote the researchers (Gastroenterology 2011 July [doi:10.1053/j.gastro.2011.03.040]).

Dr. Klek of the Jagiellonian University Medical College in Krakow, Poland, and his associates studied 78 adult patients with postoperative pancreatic fistula treated at a single academic center in Poland. All patients had a grade B fistula, according to the criteria of the International Study Group on Pancreatic Fistula. "Postoperative pancreatic fistula is the most common and potentially life-threatening complication after pancreatic surgery," they noted.

Patients were excluded if they had any cardiocirculatory, pulmonary, renal, or liver failure; if their fistula required surgical intervention; or if nutritional status was so depleted that it required both parenteral and enteral feeding.

Patients were randomized into two demographically similar groups; for 30 days, one group received enteral feeding while the other received total parenteral nutrition (TPN). All patients were treated conservatively without surgery, somatostatin analogues, or proton pump inhibitors.

Enteral feedings were started 2-4 hours after placement of a nasointestinal tube, located 20 cm below the Treitz’s ligament or, in the case of pancreaticoduodenectomy, 20 cm below the last jejeunal anastomosis. The formula, called Peptisorb (manufactured by Nutricia), contains 1 kcal/mL, is low in fat, and is peptide based, with an initial flow rate of 10 mL/hr, progressing up to 125 mL/hr.

Parenteral nutrition infusions also commenced 2-4 hours post insertion of a central venous catheter, and were prepared by the hospital pharmacy.

The mean age in both groups was 57 years, and almost half (45%) of each group was female.

Fistula closure was defined as an output of less than 10 mL during a 48-hour period, with no recurrence in the subsequent 30 days and no evidence of fluid collection on ultrasound or computed tomography scan.

At 30 days, the rate of fistula closure was 60% in the enteral group (24 of 40 patients) and 37% in the parenteral group (14 of 38 patients).

Parenteral Nutrition | Description | Precautions Purpose - Modern ...

Definition

When patients cannot use their gastrointestinal tracts for  nutrition ,   parenteral   nutrition  may be used to maintain or improve the patient's nutritional status. This form of intravenous treatment provides all the nutrients that are delivered to the patient. This treatment may be temporary or long-term.

Purpose

The harmful effects of malnutrition on the overall health of a patient are well documented. Poor nutrition  is associated with slowed or impaired recovery from illness and surgery. For wound healing, tissue maintenance, and faster recovery, patients need optimal nutritional intake. When a patient is unable to take in enough food on his own, there are two options. Enteral feeding is preferred because it is less invasive, has a lower risk for  infection ,  and is safer than the  parenteral method. Though enteral feeding is the preferred route of nutritional intake,  parenteral   nutrition plays an important role in many clinical situations. Patients who cannot consume enough nutrients on their own, or who cannot eat at all because of an illness, surgery, or an accident, may be fed through an intravenous line.

Precautions

Patients receiving  parenteral   nutrition  need to be monitored closely to ensure that the therapy is providing adequate amounts of fluids,  minerals,  and other nutrients that are needed. Laboratory testing will take place on a regular basis to monitor the patient's status.

Description

Parenteral   nutrition , also known as hyperalimentation, is subdivided into two categories: partial parenteral   nutrition  and  total   parenteral   nutrition . These categories differ by the makeup of the solutions and the site of administration.

Partial  parenteral   nutrition  (PPN) is normally prescribed for patients who can tolerate some oral feedings but cannot ingest adequate amounts of food to meet their nutritional needs. It is usually administered through a peripheral intravenous catheter. Two types of solutions are commonly used in a number of combinations for PPN: lipid emulsions and amino acid-dextrose solutions.

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Dietitian's Handbook of Enteral and Parenteral Nutrition

Handbook of total parenteral nutrition

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