CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / RecÃm-nascidos (RN) que nÃo podem obter uma nutriÃÃo adequada atravÃs do trato gastrintestinal requerem nutriÃÃo parenteral total (NPT) como terapia exclusiva ou de apoio. A NPT fornece ao paciente debilitado os eletrÃlitos necessÃrios, uma reserva protÃica adequada, e energia para os processos metabÃlicos. As fases da terapia nutricional sÃo: indicaÃÃo de suporte nutricional; prescriÃÃo mÃdica; avaliaÃÃo farmacÃutica; manipulaÃÃo das soluÃÃes, transporte, conservaÃÃo, administraÃÃo, controle clinico, laboratorial e avaliaÃÃo final. Em virtude da complexidade das etapas envolvidas, à importante a integraÃÃo da equipe multidisciplinar, de modo que a terapia seja usada racionalmente, resultando em benefÃcios ao RN quanto à seguranÃa, efetividade e qualidade. O presente trabalho objetivou monitorar a terapia nutricional em RN, observando a indicaÃÃo, a prescriÃÃo, a manipulaÃÃo e a administraÃÃo da nutriÃÃo parenteral em uma maternidade pÃblica do municÃpio de Fortaleza â CE. Foi realizado um estudo observacional, descritivo e prospectivo, envolvendo as etapas da terapia de nutriÃÃo parenteral. Os dados foram coletados a partir de um formulÃrio estruturado de acordo com o roteiro de inspeÃÃo (Portaria 272/98, ANVISA). A anÃlise estatÃstica foi executada utilizando-se o programa Statistical Package for the Social Sciences versÃo 16.0 e foi considerada significÃncia de 5%. Entre os 73 RN avaliados, 97,3% apresentaram a prematuridade como diagnÃstico principal. Com relaÃÃo Ãs prescriÃÃes mÃdicas, 2,3% nÃo foram entregues ao serviÃo de farmÃcia, 16,7% e 9% foram enviadas fora do horÃrio de entrega estabelecido e com problemas na prescriÃÃo, respectivamente. Durante a manipulaÃÃo, 0,6 e 6,15% de erros ocorreram na aspiraÃÃo e na adiÃÃo das substÃncias, respectivamente. No momento da administraÃÃo, 99% dos RN nÃo possuÃam acesso exclusivo para a NPT; assim como, 98,7% das bolsas nem 99% dos rÃtulos foram adequadamente checados. Em 36% da inserÃÃo do cateter, nenhum procedimento de limpeza foi realizado. Dessa forma, conclui-se que um melhor controle do processo envolvido na terapia nutricional e uma equipe multidisciplinar mais atuante contribuirÃo para a correÃÃo dos desvios e erros, uma vez que a prescriÃÃo, a manipulaÃÃo e a administraÃÃo representam os passos crÃticos para uma terapia bem-sucedida. / Many newborns (NB) require total parenteral nutrition (TPN) as main or adjuvant therapy, once they can not obtain an adequate nutrition through gastrointestinal system. The TPN offers to the debilitated patient the necessary electrolytes, the required protein source and the energy for metabolic processes. The nutritional therapy phases are: indication for nutritional support; medical prescription; pharmaceutical evaluation; manipulation of the solutions; delivery; conservation; administration; clinical and laboratorial controlling; and, final evaluation. Due to the complexity of the steps involved, it is important the integration of the multidisciplinary team, so that the therapy is used rationally, resulting in benefits to the NB in terms of safety, effectiveness and quality. The present work aimed to monitor the nutritional therapy in NB, observing the indication, prescription, manipulation and administration of the parenteral nutrition in a public maternity in Fortaleza â CE. It was performed an observational, descriptive and prospective study involving all phases. The data were collected from a structured formulary according to the inspection rule (Portaria 272/98, ANVISA). The statistical analysis was executed using the program Statistical Package for the Social Sciences, version 16.0, and it was considered a significance level of 5%. Among the 73 NB evaluated, 97,3% presented as main diagnostic pre-term newborn. Related to the medical prescriptions, 2,3% were not delivered to the pharmacy, 16,7 and 9% were delivered out of the established time and with problems in the prescriptions, respectively. During the manipulation, 0,6 and 6,15% of errors occurred, respectively in the aspiration or in the addition of the substances. At the moment of the administration, 99% of the NB did not have exclusive access for the TPN; neither 98,7% of the bags nor 99% of the labels were adequately checked. In 36% of catheter placement, no cleaning procedure was performed. In conclusion, the controlling of process involved in nutritional therapy and a more active multidisciplinary team will assess the correction of deviations and errors, once the prescription, manipulation and administration represent the critic steps for a successful therapy.

<p>Problemformulering: Patienters upplevelser av att nutrieras via gastrostomi eller parenteral nutrition (PN) är ett förbisett område. Det är viktigt att sjuksköterskan har en helhetssyn på patienten för att kunna ge god omvårdnad. Syftet med litteraturstudien var att beskriva patienters upplevelser av att nutrieras i hemmet via gastrostomi eller PN. Metoden var en systematisk litteraturstudie, där elva artiklar bearbetades och analyserades utifrån problemområdet. Resultat och Konklusion: När patienter behandlades i hemmet med antingen gastrostomi eller PN förändrades det dagliga livet för dem. Patienterna upplevde både positiva och negativa effekter av att nutrieras i hemmet. Det positiva med behandlingarna var enligt patienterna att de blev välnutrierade och att behandlingen räddade deras liv. Det negativa med behandlingarna var att de kunde ge fysiska, psykiska och sociala begränsningar. Trots de negativa effekterna upplevde patienterna att de positiva effekterna av behandlingen övervägde de negativa. Implikation: Det finns behov av ytterligare forskning inom området för att sjuksköterskor ska få bättre kunskap om patienters upplevelser av att nutrieras via gastrostomi och PN.</p>

Problemformulering: Patienters upplevelser av att nutrieras via gastrostomi eller parenteral nutrition (PN) är ett förbisett område. Det är viktigt att sjuksköterskan har en helhetssyn på patienten för att kunna ge god omvårdnad. Syftet med litteraturstudien var att beskriva patienters upplevelser av att nutrieras i hemmet via gastrostomi eller PN. Metoden var en systematisk litteraturstudie, där elva artiklar bearbetades och analyserades utifrån problemområdet. Resultat och Konklusion: När patienter behandlades i hemmet med antingen gastrostomi eller PN förändrades det dagliga livet för dem. Patienterna upplevde både positiva och negativa effekter av att nutrieras i hemmet. Det positiva med behandlingarna var enligt patienterna att de blev välnutrierade och att behandlingen räddade deras liv. Det negativa med behandlingarna var att de kunde ge fysiska, psykiska och sociala begränsningar. Trots de negativa effekterna upplevde patienterna att de positiva effekterna av behandlingen övervägde de negativa. Implikation: Det finns behov av ytterligare forskning inom området för att sjuksköterskor ska få bättre kunskap om patienters upplevelser av att nutrieras via gastrostomi och PN.

Parenteral nutrition is a therapy that supplies patients with all their nutritional requirements intravenously, thus eliminating the need for oral alimentation. The therapy was first introduced in the United States to hospitalized patients in the late 1960's. The benefit of long-term parenteral nutrition was soon recognized, and a program for ambulatory or home parenteral nutrition (HPN) was developed. In British Columbia, the first HPN patient was begun on such therapy in 1972. Since then, more than 50 British Columbians have received HPN. In March 1986, there were 24 patients on the program. The average annual cost per patient was $29,278 and the total 1986 operating budget was $702,660, not including costs for equipment or hospital training. Up to now, there has been no analytical assessment of the HPN program in B.C. This thesis describes the current home parenteral nutrition situation in B.C. and makes recommendations for its improvement. It looks at overall clinical outcomes (both physiological and psychosocial), at the results with different subgroups of the population, and at the cost of the HPN program in B.C., and also considers the potential of this therapy for children. In Chapter 2, the literature is reviewed and organized to cover a general description of HPN therapy, a summary of the results obtained from a number of academic centers, a review of HPN therapy in childhood and the psychosocial issues of concern to HPN patients. Chapter 3 provides a detailed description of the current HPN situation in B.C. The study methodology is described in Chapter 4 and the results in Chapter 5. The study is a descriptive analysis. Due to the lack of any obvious control group, a comparative evaluation per se was not possible. However, a Seattle study by Robb, reported in 1983, does allow for some comparison. The main sources of data were: 1. A Patient Questionnaire: The questionnaire was modelled on that used by the Seattle group. 23 B.C. patients, either on HPN at the time of questioning, or previously on the therapy, were surveyed. 19 (83%) responded. 2. A Health Professional Questionnaire: This questionnaire was compiled especially for and sent to all known health care workers in B.C. in the HPN field. 19 professionals, including physicians, nurses, pharmacists, dieticians, and administrators, were surveyed. 17 responded for a response rate of 89%. The patient survey provided basic demographic information, a description of HPN therapy received, as well as data on clinical outcomes, both physiological and psychosocial. Results showed that patient age, length of time on HPN, numbers of hours per week devoted to HPN, occupation and place of residence were the most important variables for predicting patient outcomes. Thus, patients that were older, had been on HPN less than one year, or spent more than 80 hours per week preparing and administering HPN solutions, had more physiological complaints and showed interference with more daily activities and personal relationships. Patients who were employed, rated the HPN experience more positively. Overall, patients found the HPN experience to be a positive one, although this was not true for a small group of patients. Data also indicated that B.C. patients achieved physiological results similar to the Seattle group, and to other centers reported in the literature, but appeared to have more interference with daily activities and personal relationships than did patients from the Seattle study. The health professional survey indicated that professionals considered the current situation in B.C. to be good with respect to patient training and the complication rate achieved. However, patient follow-up and the psychosocial support provided to patients were rated only fair to poor. These health care professionals cited problems with the program's organization, the need to standardize service to all patients, and the need to provide patients with pre-mixed solutions. In conclusion, some recommendations are made for improvement in the B.C. HPN program. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Indiana University-Purdue University Indianapolis (IUPUI) / Background: SMOF lipid™ infusion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil has been approved and recommended for use in adults receiving parenteral nutrition (PN). Research shows that SMOF lipid infusion is safe for use in post-operative and critically ill patients. Improved patient outcomes are linked to SMOF lipid use over traditional soybean oil lipid emulsions. Objective: The purpose of this study was to determine the effect of SMOF lipid infusion on incidence of infection, ICU length of stay, hospital length of stay, and mortality in adult trauma patients as compared to parenteral nutrition utilizing 100% soybean oil emulsion or a lipid-free, dextrose and amino acid administration. Methods and Analysis: A retrospective chart review was conducted for adult trauma patients admitted to Eskenazi Health’s surgical intensive care unit (SICU) that received PN from May 2017 to May 2020. Data were collected from the electronic health record and trauma registry. Results: Twenty-nine patients were included who met study criteria: 17 patients in the traditional lipid cohort and 12 in the SMOF lipid cohort. The length of PN therapy was comparable between the traditional and SMOF ILE groups, 13.9 days (± 11.5) and 13.3 days (± 14.3) respectively. All 12 patients in the SMOF lipid cohort received intravenous lipid emulsion (ILE) compared to 42% (n=7) of traditional lipid group patients (p=0.001). SMOF treatment group were provided 100% of estimated energy needs via PN compared to an average of 94% (± 9.7) of estimated energy needs in the traditional lipid treatment group (p=0.036). Incidence of infection during initial hospitalization was significantly lower in the SMOF treatment group (n=3, 25%) compared to the traditional lipid treatment group (n=13, 76%). Mortality was decreased in the SMOF treatment group (0%) when contrasted to the Intralipid treatment group (23.5%), p=0.04. Conclusion: Patients receiving SMOF lipid emulsion within PN therapy had better clinical outcomes compared to those receiving Intralipid soybean-lipid emulsion or a dextrose and amino acid administration.

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

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High lipid : low dextrose (HL:LD) parenteral admixture (PA) is high in polyunsaturated fatty acids (PUFA) that are sensitive to peroxidation. This study evaluated the antioxidative effect of vitamin E in both HL:LD PA and in obese cats given HL:LD PA. Natural d-α-tocopherol (Vital E-300) was added to HL:LD PA at seven concentrations (8, 12, 16, 24, 32, 48, or 64 IU/g of lipid). PA were exposed to fluorescent light for 24 hours at room temperature. Hydroperoxides were measured at baseline and 24 hours hang time. Significantly lower hydroperoxide concentrations were found with > 24 IU/g of lipid at baseline (P < 0.01). A higher d-α-tocopherol concentration was required (> 48 IU/g lipid) to lower hydroperoxides at 24 hours (P < 0.0001). HL:LD PA with 40 IU/g lipid/day d-α-tocopherol was delivered intravenously to obese cats (PA Toc⁺) over 48 hours. Control cats (PA Toc⁻) received HL:LD PA without a d-α-tocopherol supplementation. Oxidative status of cats was evaluated at baseline and 24, 48, and 96 hours. Cats in both groups exhibited an increase in MDA concentration (time effect; P < 0.0001). WBC-tGSH and WBC-GPx did not change in either group of cats. RBC-tGSH and RBC-GPx changed over time (time effects; P = 0.0005; P = 0.0016, respectively) with the PA Toc⁺ cats exhibiting a higher RBC-tGSH concentration (treatment x time interaction; P = 0.012). Serum α- and γ-tocopherol concentrations increased in PA Toc⁺ cats (treatment effect; P < 0.0001). These findings suggest that d-α-tocopherol significantly alters oxidative status in vivo. / Master of Science

Bakgrund: Behandling med parenteral nutrition innebär att näringsbehovet tillgodoses utan förtäring av föda. Behandlingen ses av anhöriga som livsavgörande och av sjuksköterskor som avancerad och resurskrävande. Syfte: Att beskriva patienters upplevelser av sin livssituation i samband med parenteral nutritionsbehandling i hemmet. Metod: En systematisk litteraturstudie med kvalitativ ansats och beskrivande syntes, där tio artiklar analyserades. Resultat: Analysen resulterade i två teman och fem subteman. De teman som framkom i resultatet var Att uppleva förändringar i vardagen och Att hantera den nya vardagen. Patienterna upplevde fysiska och sociala begränsningar samt att de var i behov av stöd från anhöriga och sjukvården. De upplevde även en oro och rädsla för komplikationer. Trots detta var patienterna tacksamma till behandlingen då den medförde en större frihet och kontroll. Slutsats: Behandling med parenteral nutrition i hemmet medför förändringar i det dagliga livet. Det innebär både möjligheter och begränsningar där patienterna uttrycker ökat behov av stöd inom flera områden. Därmed är det av betydelse för sjuksköterskor att skapa en ökad förståelse om hur patienterna upplever sin livssituation för att kunna erbjuda god omvårdnad. / Background: Treatment with parenteral nutrition means that the nutritional need is satisfied without eating. The treatment is viewed upon by relatives as life-saving and by nurses as advanced and demanding. Aim: To describe patients ́ experiences of their life situation in association with home parenteral nutrition. Method: A qualitative systematic literature study with descriptive approach, where ten articles were analyzed. Results: The analysis resulted in two themes and five subthemes. The themes that emerged was To experience changes in the daily life and To handle the new daily life. The patients experienced that they were physically and socially restricted and in need of support from relatives and healthcare. They also experienced anxiety and fear of complications. The patients were grateful despite all of this because the treatment offered them more freedom and control. Conclusion: Treatment with home parenteral nutrition resulted in changes in their everyday life. This brings possibilities and restrictions where the patients expressed an increase of support in many different areas. It is therefore important for nurses to increase their knowledge of how the patients perceive their life situation to be able to offer better care.