Bakgrund: Tidigare forskning har visat att parenteral nutrition ges till patienter som befinner sig i livets slutskede även om den medicinska nyttan är oklar. Syfte: Att genom en vetenskaplig litteraturöversikt beskriva sjuksköterskors erfarenheter av vad som är betydelsefullt i arbetet med parenteral nutrition för patienter i livets slutskede. Metod: Examensarbetet är utformat som en litteraturöversikt. Tretton artiklar med kvalitativ och kvantitativ design valdes ut. Artiklarna söktes på databaserna CINAHL och Pubmed Resultat: Delaktighet i vårdteam var av stor betydelse, ett fungerade samarbete där sjuksköterskan ville och fick möjlighet att arbeta som omvårdnadsansvarig upplevdes av sjuksköterskan resultera i god personcentrerad vård. Erfarenhet och egna känslor spelar en betydande roll i hur mycket sjuksköterskan vågar och vill vara delaktig i beslut angående PN i livets slutskede, och vilken relation som skapas med patientens närstående. Slutsats: Ökad kunskap om parenteral nutrition i livets slutskede och personcentrerad vård behövs för att sjuksköterskorna ska våga vara aktivt delaktig och stärka patienten i livets slutskede. / Background: Previous research shows that parenteral nutrition is administered to patients who are at the end of life, even though the medical benefit is unclear. Aim: Through a scientific literature review describe nurses' experiences of what is important in the work of parenteral nutrition for patients in the end of life. Method: A literature review, based on 13 articles with both qualitative and quantitative design. The articles were searched on databases CINAHL and PubMed Result: Participation in care team was of great importance, a working partnership where the nurse wanted and had the opportunity to work as a care manager experienced by nurse’s result in good person-centered care. Experience and own emotions play a significant role in how much the nurse dare and want to be involved in decisions regarding PN at the end of life , and the relationship that is created with the patient's relatives. Conclusion: Increased knowledge of parenteral nutrition in palliative care and person-centered care needed for nurses to dare to be actively involved and to strengthen the patient in the final stages of life.

Orientadores: Antonio Fernando Ribeiro, José Roberto Negrão Nogueira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-28T09:12:18Z (GMT). No. of bitstreams: 1 Hortencio_TaisDaieneRusso_D.pdf: 2122387 bytes, checksum: 6b337a8713273a2fcc11dbc17230038f (MD5) Previous issue date: 2015 / Resumo: Introdução O desenvolvimento da nutrição parenteral (NP) na década de 1960 e sua subsequente utilização na prática clínica tem tido um enorme impacto sobre os pacientes com numerosas doenças para as quais a nutrição foi impossível por outra via. Mas, esta nova tecnologia tem riscos associados, incluindo o desenvolvimento de distúrbios metabólicos, superalimentação e complicações infecciosas. Método Foram realizados dois estudos. O primeiro estudo teve como objetivo avaliar, em uma coorte histórica de pacientes pediátricos no Brasil que receberam NP individualizada e exclusiva, a prevalência de hipofosfatemia, hipocalemia e hipomagnesemia em até 48 horas antes do início da infusão de NP (P1), do 1° ao 4° dia (P2); 5° ao 7° dia (P3) e, investigar se a infusão de caloria e proteína e também a desnutrição foram relacionadas com esses distúrbios. O segundo estudo foi feito no Canadá. Trata-se de um estudo retrospectivo e multicêntrico, avaliando pacientes sob nutrição parenteral domiciliar (NPD), prospectivamente inseridos no Home Parenteral Nutrition Registry (HPN Registry) nos períodos: 2005-2008 ou 2011-2014. Mudanças na demografia, indicações para NPD, prescrição, avaliação nutricional, acesso vascular e número de infecção de cateter por 1000 dias de cateter foram avaliados. Resultados A desnutrição esteve presente em 32,8% dos 119 pacientes avaliados no primeiro estudo, 66,4% estavam em unidade de terapia intensiva pediátrica (UTI Ped), 13,5% morreram. O período de maior prevalência de distúrbios minerais foi o P1 54 (45,3%), no P2 = 35 (31,8%), no P3 = 4 (3,57%). Hipocalemia esteve relacionada à desnutrição OR 2,79 (95% CI 1,09-7,14) p = 0,045. Nos primeiros sete dias, foram infundidas calorias inferior à quantidade recomendada pelas recomendações atuais em até 84,9% dos pacientes e proteína adequada em até 75,7%. Proteína infundida acima da recomendação nos primeiros quatro dias foi relacionada com hypomagnesaemia OR: 5,66 (IC 95% 1,24 - 25,79) p = 0,033. No estudo canadense, comparando os períodos 2011-2014 com 2005-2008, as indicações para a NPD mudaram significativamente com o aumento da proporção de pacientes com câncer (37,9% versus 16,7%) e diminuição da síndrome do intestino curto (32% versus 65,5%). A taxa de infecção de cateter diminuiu de 1,58 para 0,97 por 1.000 dias de cateter; o uso de cateter tunelizado diminuiu de 64,3% para 38,0% e a proporção de cateteres centrais de inserção periférica (PICC) aumentou de 21,6% para 52,9%. Além disso, houve uma redução no número e dias de internações relacionadas à NPD, e mudanças na prescrição de energia, proteína e oligoelementos. Conclusão Hipofosfatemia, hipocalemia e hipomagnesemia foram eventos frequentes, sendo a individualização ferramenta primordial para gerenciá-los. Pacientes desnutridos tiveram maior chance de desenvolver hipocalemia e os que receberam proteína acima da recomendação tiveram mais chances de desenvolver hipomagnesemia. Os resultados sugerem uma mudança no perfil demográfico e acesso venoso no Canadá, com melhora na infecção de cateter, hospitalizações relacionadas à NPD, e prescrições / Abstract: Introduction: The development of parenteral nutrition (PN) in the 1960s and its subsequent use in clinical practice has had a huge impact on patients with numerous diseases for which nutrition was impossible by other route. But, this new technology has associated risks, including the development of metabolic disorders, overfeeding, and infectious complications. Methods We conducted two studies The first study aims to evaluate in a historical cohort of pediatric patients, the prevalence of hypophosphatemia, hypokalemia and hypomagnesaemia until 48th hours before beginning PN infusion (P1), from 1st¿4th day (P2); 5th¿7th day (P3) of PN infusion and, investigate if malnutrition, calories, and proteins infusion were correlated to these disorders. In Canada, a retrospective study evaluating patients who were prospectively entered in the registry either in 2005¿2008 or in 2011¿2014 was done. Changes in patient demography, indications for Home Parenteral Nutricion (HPN), regimen, nutritional assessment, vascular access, and number of line sepsis per 1000 catheter days were evaluated. Results Malnutrition was present 32.8% of 119 patients participants from the first study, 66.4% were in pediatric intensive care unit (PICU), 13.5% died. The P1 was the period of highest prevalence mineral disorders 54 (45.3%), P2 had 35 (31.8%) and, P3=4 (3.57%). Hypokalemia events were related to malnutrition OR 2.79 (95% CI 1.09-7.14) p = 0.045. In the first seven days, infused calories were below the amount recommended by current guidelines in up to 84.9% of patients and protein infused was adequate in up to 75.7%. Protein infused above recommendation was related to hypomagnesaemia OR: 5,66 (95% CI 1,24 ¿ 25,79) p=0,033. In 2011¿2014 compared with 2005¿2008, indications for HPN changed significantly with an increased proportion of patients with cancer (37.9% versus 16.7%) and decreased short bowel syndrome (32% versus 65.5%). The line sepsis rate decreased from 1.58 to 0.97 per 1,000 catheter days; tunnelled catheters decreased as the most frequently chosen vascular access method from 64.3% to 38.0% and the proportion of peripherally inserted central catheters (PICC) increased from 21.6% to 52.9%. In addition, there was a reduction in number, and days of hospitalizations related to HPN, and changes in the prescription of energy, proteins, and trace elements were noted. Conclusion Hypophosphatemia, hypokalemia and hypomagnesemia were frequent events, being individualization primary tool to manage them. Malnourished patients were more likely to develop hypokalemia, and patients receiving protein above the recommendation were more likely to develop hypomagnesemia. Results suggest a shift in patient demography and line access in Canada, with improvement in line sepsis, hospitalizations and HPN prescriptions / Doutorado / Saude da Criança e do Adolescente / Doutora em Ciências

The topic of the diploma thesis is micronutrients at home parenteral nutrition. In the theoretical part, parenteral nutrition is analyzed, including advantages and disadvantages, indications and contraindications. Intestinal failure is described as the most basic indication for the introduction of long-term / home parenteral nutrition. Following is the characterization and classification of micronutrients and a description of the consequences of their deficiency or surplus. Micronutrients are particularly important as cofactors and coenzymes in enzymatic reactions that would not be possible without them. The key question is whether the plasma levels show the actual state of the stock of the micronutrient in the organism, if the drop in most of the micronutrients that we find in patients reflects the actual deficiency to be substituted, or whether this decrease is an expression of their shift to other segments, the severity of the health condition. In the practical part of the diploma thesis are evaluated the levels of selected micronutrients (vitamin D, vitamin B12, folic acid, iron) in the group of patients with indication of home parenteral nutrition. The evaluation was based on laboratory analysis of patients' results. Key words: Parenteral nutrition, micronutrients, deficiency, surplus

Intravenous feeding of patients with essential and balanced nutrition is required when enteral feeding is not tolerated, therefore indicating the need for Total Parenteral Nutrition (TPN). This life-saving therapy is also associated with the increase risk of intrahepatic cholestasis. The incidence of TPN-related hepatobiliary complications is common in both adults and infants on TPN. Previous work in in vivo models suggested that one of the potential contributing factors is the aluminum contamination of TPN solutions. The mechanism by which aluminum contributes to the PNAC development, though, was unknown. Aluminum as a risk factor may influence a number of hepatocellular functions to lead to cholestasis but one possible mechanism is the potential for aluminum to cause dysfunction of those transporters responsible in the maintenance of bile flow. To provide some initial information regarding the role of aluminum as a contributing factor to cholestasis and the possible underlying mechanism, cytotoxicity studies were conducted to determine whether aluminum causes direct toxicity of HepG2 cells. Furthermore, the influence of aluminum on the mRNA expression of hepatic biliary transporters (BSEP, MRP2, MATE1, NTCP) and nuclear transcription factor (FXR) in HepG2 cells using real-time RT-PCR analysis was assessed. Since inflammation is a component of cholestasis, these investigations also involved the use of an inflammatory stimulus, lipopolysaccharide (LPS), to determine whether the effects of aluminum were exacerbated by underlying inflammation. My data suggest that for the canalicular hepatic transporters MATE1 and BSEP, aluminum at higher concentration alone as well as with LPS caused increased mRNA expression levels. In addition to this, BSEP mRNA expression was preserved and that of MATE1 was increased on LPS exposure. Given the particular importance of BSEP in the maintenance of bile flow and reported effects of drug-induced inhibition of BSEP to cause hepatic cholestasis, the influence of aluminum on BSEP (and MATE1) protein expression and activity warrant investigation. Further studies may identify that inhibition of BSEP function (and possibly MATE1) by aluminum contamination of total parenteral nutrition formulations may explain, in part, the intrahepatic cholestasis associated with parenteral nutrition.

Syfte: Litteraturöversiktens syfte var att belysa vilken påverkan parenteral nutrition har på livskvaliteten hos palliativa patienter. Metod: Denna studie har genomförts som en litteraturöversikt. Vetenskapliga artiklar har insamlats från databaserna Cinahl, Medline och Pubmed. Totalt fann författarna 12 vetenskapliga artiklar som svarade mot litteraturstudiens syfte. De utvalda artiklarna var både kvantitativa och kvalitativa. Kvalitetsgranskningen utfördes med hjälp av granskningsmallar och artiklarna som lade grunden till resultatet motsvarade medel till hög kvalitet. Resultat: Resultatet visade på att flertalet patienter kände en trygghet och lättnad när den parenterala nutritionen introducerades. Patienterna ansåg att vetskapen att deras nutritionsbehov blev tillfredsställt gjorde att de inte behövde vara rädda för att svälta ihjäl. De upplevde en ökad livskvalitet då de slapp oroa sig för födointaget och orkade medverka mera aktivt i det sociala familjelivet. Flertalet av patienterna uppgav en förbättrad livskvalitet när möjlighet gavs att få parenteral nutrition i hemmet trots att det innebar inskränkningar i familjelivet. De uppgav även en ökad styrka till att hantera bland annat sjukdomssymtom och behandlingsbiverkningar. Den parenterala nutritionen gav i vissa fall problem med biverkningar, men de flesta patienterna skattade ändå livskvaliteten högre av att få näringsdroppet. Resultatet visade även på att om den parenterala nutritionen sattes in i ett tidigt skede kunde en förbättring av nutritionsstatusen ske och patienterna behöll sin kroppsvikt under en något längre tid. Det resulterade i en ökad skattning av livskvaliteten. De sista veckorna i livet hade näringsdroppet ingen mätbar positiv effekt.

Thesis (M.S.)--University of Michigan, 1982.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted. Includes summaries in Swedish and Chinese. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1982.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted. Includes summaries in Swedish and Chinese. Includes bibliographical references.

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.