Class of 2005 Abstract / Objectives: To develop a decision analytic model to compare the clinical and economic outcomes of enteral nutrition (EN) and total parenteral nutritional (TPN) support in acute pancreatitis patients. Methods: All randomized clinical trials comparing EN and TPN in acute pancreatitis patients published in the medical and pharmacy literature were identified. Six trials were identified by searching MEDLINE, Web of Science, Cochrane Controlled Trials Register, International Pharmaceutical Abstracts, HealthStar, Cumulative Index to Nursing & Allied Health Literature, and citation review of applicable literature. The costs used for the decision tree were from the perspective of a hospital. A literature based decision tree was formed based from these costs and the probabilities of events from the six identified clinical trials. The TreeAge Pro computer program (TreeAge Software, Inc.; Williamstown, MA) was used to conduct the cost effectiveness analysis. Therapeutic success was considered, for the purposes of the trial, as having no complications. Results: EN was associated with a lower risk of infections, a reduced length of hospital stay, and fewer surgical interventions. There was no statistical difference in the risk of mortality, adult respiratory distress syndrome or multiple organ failure between groups treated with EN or TPN. The results found that EN dominated TPN by being both less costly and more effective. The average costs for EN and TPN were $46,345 and $73,878, respectively. The success rates were 0.652 and 0.358 for EN and TPN, respectively. Conclusion: Enteral nutrition was the dominant route of administration for nutritional support, when compared to total parenteral nutrition both clinically and economically for acute pancreatitis patients.

Total parenteral nutrition (TPN) provides an experimental situation where adequate nutrition is provided intravenously, bypassing the gastrointestinal tract. Under these conditions the importance of orally ingested nutrients in the control of gastric and pancreatic endocrine secretion can be assessed. The objectives of this thesis were two-fold. First, to examine the effects of TPN on the enteroinsular axis component of insulin secretion. Second, to study the importance of orally ingested nutrients in the regulation of gastric hormone secretion using the TPN rat model. In order to carry out these objectives, techniques for TPN and enteral feeding (TEN) of the rat were first developed. A dietary regimen for use in TPN and TEN rats was formulated from commercially-available, human TPN components. Under most circumstances, the TPN/TEN regimen met or exceeded the nutritional requirements for growing rats, as determined by the National Research Council (1978). Hematological analysis revealed few side effects of — intravenous or intragastric feeding. Parenterally and enterally-fed animals demonstrated comparable weight gain to that of a control group (ORAL) fed a rat chow (#5012, Ralston Purina) diet ad libitum. In addition, both TPN and TEN animals appeared healthy after the 7-day infusion period. These studies indicated that the infusion formulation was suitable for chronic intravenous and intragastric feeding. In the first series of experiments, the effects of TPN and TEN on the hormonal component of the enteroinsular axis were studied. TPN animals exhibited hyperinsulinemia and mild hyperglycemia. Conversely, TEN animals exhibited normal plasma glucose and immunoreactive insulin (IRI) concentrations. These data suggested that enterally delivered nutrients were assimilated with greater efficiency than intravenously administered nutrients. It was hypothesized that gut factors normally released by oral food intake facilitated the disposal of nutrients by hepatic and/or peripheral tissues. During the infusion period, TPN animals exhibited chronically depressed circulating IR-gastric inhibitory polypeptide (GIP) levels, in contrast to TEN animals where IR-GIP was elevated. Seven days of TPN or TEN resulted in no change in fasting plasma IRI or IR-GIP levels. However, an exaggerated insulin response to an oral glucose challenge (OGC) occurred after TPN, while the glucose response was reduced. The insulin response from the perfused pancreata of TPN animals to a GIP gradient was 20% and 40% greater than from ORAL and TEN pancreata respectively. Shorter periods of TPN (3 and 5-day periods) indicated that the hypersensitivity of the pancreas to GIP was a progressive condition, increasing with longer periods of infusion. Immunocytochemical and morphometric analysis revealed no differences in the jejunal GLP-cell population after chronic (7-day) intravenous or intragastric feeding. In addition, these routes of feeding had no effect on pancreatic islet area or endocrine cell composition of the islets. Based on these results, it was hypothesized that the increased B-cell sensitivity to GIP may have been causally related to the exposure of the pancreas to chronically low plasma GIP levels during the infusion period. To further test this hypothesis, chronically depressed plasma GIP levels, observed during TPN, were elevated by exogenous GIP infusion to levels seen in TEN rats. Chronic GIP —treatment in TPN animals (TPN-GIP) resulted in normalization of the insulin response to an OGC and in the in vitro insulin response of the isolated pancreas to GIP. These data were taken as further evidence that B-cell sensitivity to GIP was affected by ambient plasma GIP levels, and it was hypothesized that changes in sensitivity may be mediated by alteration at the receptor or post-receptor level. The effect of TPN on nutrient and neuronally mediated insulin release was also investigated. During TPN, metabolites and neuronal elements provided the main stimulus for insulin release, since hormonal components of the enteroinsular axis remained inactive. The present experiments indicated that the B-cell was hypersensitive to glucose, vagal stimulation and the cholinergic agonist methacholine, but normally sensitive to vasoactive intestinal polypeptide (VIP) and the insulinotropic amino acid arginine. These results indicated that TPN was associated with an increased B-cell sensitivity to specific hormonal, nutritive and neuronal stimuli. It was hypothesized that an increased B-cell sensitivity to these specific stimuli contributed to hyperinsulinemia observed in TPN animals during the infusion period, and to the exaggerated insulin response observed after an oral glucose challenge. Total parenteral nutrition also provided an experimental situation in which to study the importance of gastric nutrients in the regulation of Gl-hormone secretion. TPN resulted in a rapid and progressive depletion of circulating gastrin levels. G-cell secretory activity in vivo under basal and stimulatory conditions was also reduced by TPN. This condition persisted in vitro in the isolated stomach. The antral G-cell population was shown to decrease progressively with longer TPN periods, but G-cell hypoplasia and reductions in antral gastrin content were less dramatic than reductions in G-cell secretory activity. It was hypothesized that reductions in G-cell secretory activity were in part causally related to antral G-cell hypoplasia. The present data further suggested, however, that mechanisms which control synthesis and/or secretion within G-cells may have also been impaired, since various stimulants of gastrin release could not reverse gastrin hyposecretion observed during basal periods. Gastrin hyposecretion also could not be reversed by chronic bombesin administration, but was reversed by a 6-day period of oral — refeeding, indicating that the presence of nutrients in the gastric lumen was the primary regulator of tissue gastrin levels and G-cell secretory activity. The gastric D-cell was much less affected by the absence of nutrients in the gastric lumen than was the G-cell, and antral somatostatin hypersecretion may have contributed to G-cell hyposecretion. The experiments presented in this thesis indicated that total parenteral nutrition had marked effects on both B- and G-cell secretory activity. These studies clearly demonstrated the importance of enteral feeding in the maintenance of normal pancreatic and gastrointestinal endocrine secretion. / Medicine, Faculty of / Cellular and Physiological Sciences, Department of / Graduate

Orientador: Gabriel Hessel / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T12:37:09Z (GMT). No. of bitstreams: 1 Freitas_RenataGermanoBorgesdeOliveiraNascimento_M.pdf: 1569637 bytes, checksum: b72c8890e15da5747d9f2995f98d2fda (MD5) Previous issue date: 2014 / Resumo: O objetivo geral do estudo foi avaliar o estado nutricional e suas relações com a atividade inflamatória e a prescrição da nutrição parenteral (NP) de pacientes internados em um hospital terciário em uso de NP. Métodos: A pesquisa foi longitudinal e desenvolvida em 3 capítulos. A coleta de dados foi realizada durante as primeiras 72 horas, no 7º e 14º dia de uso da NP entre os adultos (2 primeiros capítulos). Entre os pacientes pediátricos, foram computados os dados de 24 horas anteriores às individualizações da NP (capítulo 3). Os exames laboratoriais realizados foram: albumina, proteína C reativa (PCR), pré-albumina, colesterol total, HDL, triglicerídeos (TGL) e creatinina, glutationa peroxidase (GPx), sódio, potássio, cálcio iônico, cloreto, magnésio e fósforo inorgânico. A avaliação da gravidade foi determinada pelo cálculo do escore de Acute Physiologic and Chronic Health Evaluation (APACHE II) e Sequential Organ Failure Assessment (SOFA). Com os dados do peso e da altura, foi calculado o Índice de Massa Corporal (IMC) e com a circunferência braquial (CB) e a prega cutânea tricipital (PCT), foram calculados as medidas derivadas: circunferência muscular do braço (CMB), área muscular braquial corrigida (AMBc) e área adiposa braquial (AAB). A prescrição energética dos pacientes foi realizada de acordo com a ESPEN (2009), e ASPEN (2002) para adultos e segundo a ASPEN (2010) e a ESPGHAN (2005) para os pediátricos. Foi comparada a recomendação calórica das fórmulas Harris Benedict (HB) e ESPEN 2009. Resultados: Entres os 88 pacientes avaliados, apesar da maioria ter sido classificada como normoponderal pelo IMC (55,36%), a depleção de massa magra foi predominante segundo AMBc (93,33%) e CMB (62,5%). Os níveis da PCR estavam elevados e albumina, pré-albumina e GPx, baixos. Ao longo do estudo a pré-albumina aumentou (p=0.0261). Houve diferença entre as fórmulas (25kcal/kg/dia) e HB (p?0,0001). Entre os 53 pacientes da unidade de terapia intensiva (UTI), 20 (37,74%) foram a óbito. Foi encontrada diferença significativa do SOFA com o desfecho e uma tendência inversamente proporcional do IMC com o óbito. Foi encontrada correlação negativa e forte entre o SOFA e a pré-albumina (r = -0.64; p = 0.05). Com relação aos 12 pacientes pediátricos (49 individualizações), a maioria foi classificada com desnutrição. Observou-se que 74/254 (29,2%) dos exames bioquímicos demandaram NP individualizada por motivos indubitáveis. Conclusões: O IMC parece estar relacionado com a inflamação. Os valores baixos de pré-albumina e albumina indicam desnutrição e/ou processo inflamatório. A aplicação da fórmula (25kcal/kg/dia), já padronizada, contribuiu com a melhora do estado nutricional, evidenciado pelos valores de pré-albumina. Entre os pacientes da UTI, o SOFA foi um bom instrumento para avaliação prognóstica. A albumina foi um marcador para desnutrição. É possível que o IMC seja um parâmetro para avaliação prognóstica do paciente. Entre os pediátricos, o estado nutricional dos pacientes foi considerado crítico, na maioria dos casos. Desta forma, a individualização realizada no início da NP para a adequação energética proteica é essencial. Além disto, a NP individualizada foi indispensável em, no mínimo, 29,2% das NP, para correção das alterações dos exames bioquímicos / Abstract: This study aimed to evaluate the nutritional state and its relationships with inflammatory activity and parenteral nutrition (PN) prescription of patients using PN hospitalized in a tertiary hospital. Methods: The research was longitudinal and developed in three chapters. The data collection was performed during the first 72 hours, on the 7th and 14th days using PN in adults (two first chapters). The data from pediatric patients were computed 24 hours before PN individualizations (chapter 3). The following laboratory examinations were performed: albumin, reactive C-protein (RCP), prealbumin, total cholesterol, HDL, triglycerides (TGL) and creatinine, glutathione peroxidase (GPx), sodium, potassium, ionized calcium, chloride, magnesium, inorganic phosphorus. The evaluation of severity was determined by the calculation of the score of Acute Physiologic and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA). The body mass index (BMI) was calculated using weight and height, and using brachial circumference (BC) and triceps skinfold thickeness (TST), the following derived measurements were calculated: mid arm muscle circumference (MAMC), corrected arm muscle area (CAMA) and arm fat area (AFA). The energy requirement of patients was performed according to the ESPEN (2009) and ASPEN (2002) for adults, and the ASPEN (2010) and ESPGHAN (2005) for pediatric patients. The calorie recommendation of the formulas Harris Benedict (HB) and ESPEN 2009 were compared. Results: Among the 88 evaluated patients, although most of them has been classified as normoponderal by the BMI (55.36%), malnutrition was prevalent according to AMBc (93.33%) and CMB (62.5%). While the PCR levels were elevated, albumin, prealbumin and GPx levels were low. During the study, prealbumin increased (p=0.0261). There was difference between the formulas (25kcal/kg/day) and HB (p?0.0001). Amont the 53 patients in the intensive therapy unit (ITU), 20 (37.74%) died. It was found a significant difference of SOFA with outcome, and a inversely proportional trend of BMI with death. There was a negative and strong correlation between SOFA and prealbumin (r = -0.64; p = 0.05). Most of the 12 pediatric patients (49 individualizations) were classified as having malnutrition. It was observed that 74/254 (29.2%) of biochemical examinations demanded individualized PN due to indubitable reasons. Conclusions: BMI seems to be related to inflammation. The low values of prealbumin and albumin indicate malnutrition and/or inflammatory process. The application of the already standardized formula (25kcal/kg/day) contributed to an improvement in the nutritional state, evidenced by prealbumin values. SOFA was a good instrument for prognostic evaluation in patients in the ITU. Albumin was a marker of malnutrition. It is possible that the BMI is a parameter for prognostic evaluation of patients. The nutritional state of most pediatric patients was considered critical. Thus, the individualization performed in the beginning of the PN for energy protein adequacy is essential. In addition, the individualized PN was indispensable in at least 29.2% of PN, for correction of alterations of biochemical examinations / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

Introduction Patients with intestinal failure (IF) develop problems of malabsorption and malnutrition associated with short bowel syndrome (SBS). Home parenteral nutrition (HPN) became available to treat these patients since the 1970s. There is a paucity of qualitative research on patients’ experiences in the UK. The study aim was to generate theory that explains the experiences of adults living with HPN and complex medication regimens. Method The grounded theory methodology was used to explore the experiences and to generate theory about this health intervention. Twelve participants were interviewed. The interviews were recorded and transcribed verbatim. The joint process of data collection and analysis followed the principles of constant comparative approach. Results The core categories of stoma care and HPN treatment were supported by the subcategories of maintaining stoma output, access to toilets, maintaining HPN infusion routine, access to technical help to set up HPN infusion, and general health changes. Strategy used to manage living with loss was demonstrated by the subcategory of maintaining daily activities and social interactions. Discussion The theory of living with loss suggests that patients with a stoma receiving HPN experience the sense of loss at home and in social situations. Opportunities for professional practice development are detailed along with implications for future research. Conclusions The findings resonate with the Kubler-Ross Model of the five stages of grief (Kubler-Ross, 1970). The theory of living with loss was generated by the use of the grounded theory methodology. This study identified opportunities for changes and improvement in clinical practice.

No / Aim The aim of this review is to summarise the literature relating to patients’ experiences with home parenteral nutrition (HPN). Method This literature review is based on searches of CINAHL, PubMed, Web of Knowledge and Web of Science for articles published between 1970 and 2013. Additional studies were included from Department of Health publications, NICE clinical guidance, UK patient support group with interests in HPN or intestinal failure (IF). Results Patients with severe IF have been successfully treated with HPN since the 1970s. Early published studies evaluated clinical outcomes such as catheter-related infections, metabolic complications, thrombosis of the catheterised vein and liver impairment. Since the 1980s questionnaire studies were used to evaluate the quality of life (QoL) of patients treated with HPN. These early studies used QoL assessment tools which were not validated for patients treated with HPN. Internationally, there were published qualitative research studies which explored the experiences of patients treated with HPN. Conclusions The long-term outcome of patients treated with HPN continues to attract research interest. The review of the literature did not identify any published qualitative studies on the experiences of patients treated with HPN in the UK, suggesting a gap in the research. The UK National Health Service advocates a patient-centred approach for service design and delivery in primary and secondary care. This literature review has highlighted opportunities for qualitative research into the experiences of patients living with HPN to achieve better understanding and awareness of the rehabilitation of these patients

Yes / Background & aims Parenteral nutrition (PN) provides nourishment and hydration as an intravenous infusion to patients with intestinal failure (IF). The aim of the study is to generate theory that explains the experiences of adult patients living with home parenteral nutrition (HPN) and complex medication regimens. Methods A grounded theory methodology was used to explore the experiences of twelve patients receiving HPN. A semi-structured interview was conducted and recorded in each participant's home setting. Each interview was transcribed verbatim. The simultaneous process of data collection and analysis was followed reflecting the principles of the constant comparative approach. Results A total of 15 patients gave written consent, with 12 of them agreeing to be interviewed. All the participants had previously undergone surgery as a result of chronic ill health or sudden illness. Analysis revealed two core categories: stoma and HPN, and these were supported by the subcategories: maintaining stoma output, access to toilets, managing dietary changes, maintaining the HPN infusion routine, access to technical help to set up an HPN infusion, mobility with HPN equipment and general health changes. The strategy of living with loss was demonstrated by all the participants, and this was supported by the action strategies of maintaining daily activities and social interactions. Conclusions This study generates new understanding and insight into the views and experiences of patients receiving HPN in the UK. The findings from these participants have been shown to resonate with the Kubler-Ross Model [1] of the five stages of grief. The theory of living with loss was generated by the use of a grounded theory methodology. This small scale exploratory study reveals opportunities for improvements in practice to be considered by the nutrition support team (NST) and other healthcare professionals involved in the patient's hospital stay prior to discharge on HPN.

Background: Recent research is revealing the high rate of false-positive screening results for IEMs in the NICU population. No study published to date has specifically studied the possible relationship between nutrition and newborn screening in this population. Objective: It is suspected that NICU infants who receive PN are more likely to have abnormal newborn screening results than infants who receive EN. An understanding of the role of nutrition will assist in developing protocols for screening in the NICU and decrease false-positives. Design: Infants admitted to the NICU between January 1-June 30, 2009 were included in this retrospective chart review study (n=339). The type of nutrition and timing of its initiation was recorded and compared to newborn screening results to identify correlations with false-positives. Statistical analysis included means, percentages, Fisher's exact test, Chi-square test, and the Cochran-Mantel-Haenszel test. Results: Nutrition type was significantly associated with newborn screening (p<0.001); those who received parenteral nutrition were more likely to have a false-positive. For infants who also received PN, EN of breast milk exclusively increased risk of an abnormal screen more than formula exclusively or breast milk plus formula. The timing of parenteral nutrition had no effect on screening. Premature infants who received PN exclusively had a higher percentage of false-positives than those who received EN Conclusions: Although the hypothesis could not be statistically supported, PN appears to contribute to false-positive newborn screens. More research is needed to ascertain the role of EN and GA in newborn screening and to develop standardized protocols. / Master of Science

A hiperlipemia causa sérias complicações aos equinos hospitalizados, principalmente quando associada ao estresse, doenças e traumas. Tratamentos convencionais com soluções de heparina, glicose a 5%, insulina, entre outras, têm sido utilizados em equídeos predispostos, mas são questionados quanto ao seu real efeito. O interesse e as pesquisas em relação à utilização da nutrição clínica no equino, em especial a nutrição parenteral, vêm crescendo. Sua ação visa evitar a doença e o catabolismo através da regulação do balanço energético negativo, inclusive servindo de adjuvante às terapias já implementadas no tratamento da doença primária, fornecendo o requerimento básico nutricional para a manutenção e recuperação do organismo. Para avaliar a eficácia das soluções de nutrição parenteral em equinos que desenvolveram hiperlipidemia durante a internação, foram avaliados 14 equinos atendidos com afecções diversas e que apresentaram triglicérides séricos (TG) acima de 150mg/dl. Os mesmo foram divididos em dois grupos: grupo controle (G1), sem interferência do manejo e grupo tratamento (G2), que recebeu nutrição parenteral parcial sem lipídeos. Tais soluções eram compostas de glicose a 50%, aminoácido a 10%, oligoelementos, complexo vitamínico e eletrólitos e foram infundidas até a resolução da hiperlipidemia. Os animais dos dois grupos foram monitorados diariamente em relação aos valores de glicemia, triglicérides e colesterol. A média do tempo de redução dos TG no G1 foi de 209,2 ± 131,9 horas e no G2 foi de 34,9 ± 41,8 horas, com diferença estatística entre eles. Os valores de colesterol não acompanharam a elevação dos TG. Em relação à perda de peso e escore corporal, os dois grupos apresentaram redução durante a internação, sem diferença estatística entre eles. Nenhum animal do G2 desenvolveu hiperlipemia, ao contrário do G1, em que cinco equinos apresentaram, em algum momento da internação, triglicérides acima de 500mg/dl. Embora outros critérios devam ser utilizados na escolha dos pacientes que necessitam deste tipo de tratamento devido principalmente aos custos e necessidade de constante monitorização, conclui-se que a nutrição parenteral é um método rápido e seguro para a prevenção da hiperlipemia em equinos com hiperlipidemia durante a internação por outras enfermidades. / The hyperlipemia cause serious complications for hospitalized horses, especially when associated with stress, diseases and traumas. Conventional treatments with solutions of heparin, 5% glucose, insulin, among others, have been used in susceptible equine, but they are asked about their real purpose. The interest and research on the use of clinical nutrition in the horse, especially parenteral nutrition, growing. Its action is to avoid disease and catabolism by regulating the negative energy balance, including serving as adjuvant therapies have been implemented in the treatment of primary disease, providing the basic nutritional requirement for the maintenance and recovery of the body. To evaluate the effectiveness of parenteral nutrition solutions in horses that developed hyperlipidemia during hospitalization were evaluated 14 horses treated for various diseases and who had serum triglycerides (TG) above 150mg/dl. The same were divided into two groups: control group (G1), without interference from management and treatment group (G2), which received partial parenteral nutrition without lipids. Such solutions were composed of 50% glucose, 10% amino acid, trace elements, electrolytes and vitamin and were infused until resolution of hyperlipidemia. The animals of both groups were monitored daily in relation to blood glucose, triglycerides and cholesterol. The median reduction in TG G1 was 209.2 ± 131.9 hours and G2 was 34.9 ± 41.8 hours, with no statistical difference between them. Cholesterol values did not follow the elevation of TG. In relation to weight loss and body score, both groups decreased during hospitalization, with no statistical difference between them. No animals developed hyperlipidemia G2, unlike the G1, in which five horses had, at some time in hospital, triglycerides greater than 500mg/dl. Although other criteria should be used to select patients in need of such treatment primarily due to cost and the need for constant monitoring, it is concluded that parenteral nutrition is a rapid and reliable method for the prevention of hyperlipemia with hyperlipidemia in horses during the hospitalization for other diseases.

Uma solução de glicerofosfato de sódio, estéril e apirogênica para administração intravenosa, não disponível comercialmente no Brasil, foi desenvolvida e adicionada às nutrições parenterais padronizadas no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, com o objetivo de fornecer fósforo juntamente com o cálcio. Essas nutrições parenterais foram preparadas adicionando-se 4 mmol/dL de fósforo e 3,712 mmol/dL de cálcio, utilizando-se como fonte as soluções de glicerofosfato de sódio a 1 mmol/mL e gluconato de cálcio a 10%(p/v), respectivamente, e mantidas à temperatura de 5±3ºC por 0, 6, 12 e 24 horas, seguidas de 24 horas à temperatura ambiente (24±3ºC) e posteriormente avaliadas microscopicamente, quando preparadas com emulsão lipídica, com aumento de 400 vezes, e macroscopicamente após centrifugação a 6390 g. As preparações sem emulsão lipídica foram avaliadas macroscopicamente nas mesmas condições e também após a manutenção em temperaturas de 5±3ºC, 24±3ºC e 37°C, durante 96 horas. Em nenhuma formulação, contendo ou não emulsão lipídica, foi verificada a presença do precipitado de fosfato de cálcio. Conclusão: O glicerofosfato de sódio, quando adicionado às nutrições parenterais juntamente com o gluconato de cálcio em quantidades e nas condições avaliadas, não apresentou incompatibilidade in vitro. / A sterile and apyrogenic sodium glycerophosphate solution for intravenous administration, not commercially available in Brazil, was developed and added to standard parenteral nutrition formulations used at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, in order to supply phosphorus together with calcium. These parenteral nutrition formulations were prepared by adding 4 mmol/dL phosphorus and 3.712 mmol/dL calcium using as sources solutions of 1 mmol/mL glycerophosphate and 10% calcium gluconate (w/v) and kept at a temperature (5 + 3oC) for 0, 6, 12 and 24 hours, followed by 24 hours at room temperature of 24 + 3oC. The formulations were then evaluated microscopically, at 400 X magnification, when prepared with a lipid emulsion, and macroscopically after centrifugation at 6390 g. The preparations without a lipid emulsion were evaluated macroscopically under the same conditions and also after being kept at temperatures of 5 + 3oC, 24 + 3oC and 37oC for 96 hours. No calcium phosphate precipitates were observed in any formulation containing or not a lipid emulsion. We conclude that sodium glycerophosphate, when added to parenteral nutrition formulations together with calcium gluconate in the amounts and under the conditions tested here did not present in vitro incompatibility.

Bakgrund: artificiell nutrition är en behandling som förekommer i vården och skapar olika upplevelser hos patienter, bland annat oro och sociala begränsningar vid behandlingen. Anhöriga upplever även de en oro men även en okunskap över situationen. För att uppnå trygghet behöver patienter och deras anhöriga stöttning samt vägledning av sjuksköterskor. Syfte: att skapa en översikt över sjuksköterskors upplevelser av artificiell nutrition. Metod: allmän litteraturöversikt enligt Friberg, där 15 artiklar med kvalitativa och kvantitativa ansatser valdes ut. Resultat: liknande syften sågs i flertalet studier och en av de vanligaste metoderna för att samla in data var via intervjuer. I resultatet skapades tre teman för att lyfta fram aspekter av ansvar, kunskaper samt sjuksköterskors möte med artificiell nutrition. Bland annat visade det att olika ansvarsroller, tidsbrist samt sjuksköterskors tidigare kunskaper hade betydelse för vården av patienter och anhöriga. Slutsats: sjuksköterskors erfarenheter skapar en tryggare vård för anhöriga samt för de patienter som behandlas med artificiell nutrition. Ansvar i vården och kunskapen om artificiell nutrition är två andra aspekter som är avgörande för hur sjuksköterskor förhåller sig till vårdandet kring artificiell nutrition.