RESUMO
This guideline covers parenteral nutrition (intravenous feeding) for babies born preterm, up to 28 days after their due birth date and babies born at term, up to 28 days after their birth. Parenteral nutrition is often needed by preterm babies, critically ill babies, and babies who need surgery.
Assuntos
Humanos , Recém-Nascido , Lactente , Unidades de Terapia Intensiva Neonatal/organização & administração , Serviços de Saúde da Criança/organização & administração , Nutrição Parenteral/enfermagem , Soluções de Nutrição Parenteral/uso terapêuticoAssuntos
Adaptação Psicológica , Relações Enfermeiro-Paciente , Distúrbios Nutricionais/enfermagem , Nutrição Parenteral/enfermagem , Relações Profissional-Paciente , Melhoria de Qualidade , Barreiras de Comunicação , Análise Custo-Benefício , Inglaterra , Gastroscopia/enfermagem , Gastrostomia/enfermagem , Humanos , Auditoria de EnfermagemRESUMO
Parenteral nutrition (PN) is a highly complex medication and its provision can be prone to a variety of errors. Safe administration of this therapy requires that the competency of clinicians, particularly nurses, be demonstrated using a standardized process. In this document, a standardized model for PN administration competency is proposed based on a competency framework, the ASPEN-published interdisciplinary core competencies, discipline-specific standards of practice, safe practice recommendations, and clinical guidelines. ASPEN recognizes that all healthcare institutions may not currently meet the aspirational goals of this document. This framework will guide institutions and agencies in developing tools and procedures and maintaining competency of staff members around safe PN administration. The ASPEN Board of Directors has approved this document.
Assuntos
Competência Clínica , Intubação Gastrointestinal/efeitos adversos , Nutrição Parenteral/efeitos adversos , Segurança do Paciente , Guias de Prática Clínica como Assunto , Lista de Checagem , Competência Clínica/normas , Filtração , Humanos , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/enfermagem , Intubação Gastrointestinal/normas , Ciências da Nutrição/educação , Ciências da Nutrição/métodos , Nutrição Parenteral/instrumentação , Nutrição Parenteral/enfermagem , Nutrição Parenteral/normas , Segurança do Paciente/normas , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Sociedades Científicas , Estados UnidosRESUMO
Critically ill patients have increased metabolic requirements and must rely on the administration of nutritional therapy to meet those demands. Yet, according to research almost half of all hospitalized patients are not fed, are underfed, or are malnourished while in the hospital. This article demonstrates the importance of early feedings in critical care unit, and the available options open to nurses supporting initiation and management of early feedings. Enteral nutrition has proven to be an important therapeutic strategy for improving the outcomes of critically ill patients and the critical care nurse plays an integral role in their success.
Assuntos
Enfermagem de Cuidados Críticos , Nutrição Enteral , Necessidades Nutricionais , Nutrição Parenteral , Cuidados Críticos/métodos , Estado Terminal , Ingestão de Energia , Nutrição Enteral/métodos , Nutrição Enteral/enfermagem , Humanos , Unidades de Terapia Intensiva , Papel do Profissional de Enfermagem , Nutrição Parenteral/métodos , Nutrição Parenteral/enfermagemRESUMO
The aim of this article is to provide an overview of what parenteral nutrition (PN) is and when its use is required. It will describe the process of nutritional assessment, and considerations when choosing venous access. The different approaches to provision of PN solutions in hospital will be discussed. Catheter-related and metabolic complications can occur during delivery of PN; there will be a discussion of the different types of complications and how these can be avoided or minimised. Finally, the pivotal role of the nurse in the assessment and ongoing care of patients who require PN will be highlighted, including skills required to administer PN safely.
Assuntos
Enteropatias/terapia , Nutrição Parenteral/enfermagem , Infecções Relacionadas a Cateter , Cateteres Venosos Centrais , Ácidos Graxos Essenciais/deficiência , Humanos , Hiperglicemia/etiologia , Hiperlipidemias/etiologia , Papel do Profissional de Enfermagem , Avaliação Nutricional , Nutrição Parenteral/efeitos adversos , Desequilíbrio Hidroeletrolítico/etiologiaRESUMO
BACKGROUND: This prospective randomised study was designed to evaluate the efficacy of intradialytic parenteral nutrition (IDPN) therapy in malnourished patients with refractory anaemia. METHODS: Forty patients who were malnourished with a BMI not greater than 23 (17-23) kg/m2 , undergoing regular HD were included. Of those, 20 patients received 500-1000 ml of IDPN at a rate of 250-300 ml/h at each HD session three days per week for six consecutive months. The other 20 patients did not receive IDPN infusion. The malnutrition inflammation score (MIS) and haematological parameters were recorded at baseline and after three and six months. RESULTS: Mean haemoglobin levels, BMI and serum albumin were significantly increased while MIS was significantly decreased after the 3rd and 6th months of IDPN. CONCLUSION: IDPN has a good role in improving refractory anaemia by significantly increasing haemoglobin levels, body weight, and serum albumin levels. The intervention also significantly decreases the MIS of patients.
Assuntos
Anemia Refratária/prevenção & controle , Nutrição Parenteral/normas , Diálise Renal/efeitos adversos , Resultado do Tratamento , Adulto , Peso Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Nutrição Parenteral/métodos , Nutrição Parenteral/enfermagem , Estudos Prospectivos , Insuficiência Renal Crônica/terapiaRESUMO
BACKGROUND: Enteral nutrition (EN) is recommended as the preferred route for early nutrition therapy in critically ill adults over parenteral nutrition (PN). A recent large randomized controlled trial (RCT) showed no outcome differences between the two routes. The objective of this systematic review was to evaluate the effect of the route of nutrition (EN versus PN) on clinical outcomes of critically ill patients. METHODS: An electronic search from 1980 to 2016 was performed identifying relevant RCTs. Individual trial data were abstracted and methodological quality of included trials scored independently by two reviewers. The primary outcome was overall mortality and secondary outcomes included infectious complications, length of stay (LOS) and mechanical ventilation. Subgroup analyses were performed to examine the treatment effect by dissimilar caloric intakes, year of publication and trial methodology. We performed a test of asymmetry to assess for the presence of publication bias. RESULTS: A total of 18 RCTs studying 3347 patients met inclusion criteria. Median methodological score was 7 (range, 2-12). No effect on overall mortality was found (1.04, 95 % CI 0.82, 1.33, P = 0.75, heterogeneity I(2) = 11 %). EN compared to PN was associated with a significant reduction in infectious complications (RR 0.64, 95 % CI 0.48, 0.87, P = 0.004, I(2) = 47 %). This was more pronounced in the subgroup of RCTs where the PN group received significantly more calories (RR 0.55, 95 % CI 0.37, 0.82, P = 0.003, I(2) = 0 %), while no effect was seen in trials where EN and PN groups had a similar caloric intake (RR 0.94, 95 % CI 0.80, 1.10, P = 0.44, I(2) = 0 %; test for subgroup differences, P = 0.003). Year of publication and methodological quality did not influence these findings; however, a publication bias may be present as the test of asymmetry was significant (P = 0.003). EN was associated with significant reduction in ICU LOS (weighted mean difference [WMD] -0.80, 95 % CI -1.23, -0.37, P = 0.0003, I(2) = 0 %) while no significant differences in hospital LOS and mechanical ventilation were observed. CONCLUSIONS: In critically ill patients, the use of EN as compared to PN has no effect on overall mortality but decreases infectious complications and ICU LOS. This may be explained by the benefit of reduced macronutrient intake rather than the enteral route itself.
Assuntos
Estado Terminal/enfermagem , Nutrição Enteral/enfermagem , Estado Nutricional/fisiologia , Nutrição Parenteral/enfermagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Estado Terminal/epidemiologia , Nutrição Enteral/métodos , Humanos , Unidades de Terapia Intensiva , Nutrição Parenteral/métodosAssuntos
Suplementos Nutricionais/estatística & dados numéricos , Nutrição Parenteral/enfermagem , Deficiência de Vitamina B 12/enfermagem , Vitamina B 12/administração & dosagem , Canadá , Estudos de Coortes , Relação Dose-Resposta a Droga , Humanos , Deficiência de Vitamina B 12/tratamento farmacológicoRESUMO
BACKGROUND: There is a paucity of studies, which have described malnutrition in patients with acquired brain injury (ABI) across etiology. This study describes weight change, malnutrition, and potential associations in patients with ABI at a subacute inpatient rehabilitation hospital. METHOD: This is a descriptive cohort study. Ninety-eight patients were admitted in a 3-month period, of whom n = 76 met inclusion criteria. The Malnutrition Universal Screening Tool was used for categorizing patients according to risk of malnutrition. RESULTS: Patients had experienced weight loss of 5.59% ± 5.89% (p < .001) at admission at the rehabilitation hospital, and patients with traumatic brain injury had experienced a greater weight loss than patients with stroke (p < .01). Thirty percent of patients were at high risk for malnutrition, and 52% of these patients received enteral or parenteral nutrition at admission at the rehabilitation hospital. No association was found between risk of malnutrition and severity of injury, complications, functional outcome, or length of stay. CONCLUSION: RESULTS underline the importance that nurses, especially in acute care, adhere to clinical guidelines to minimize weight loss. Special attention should be on patients with traumatic brain injury. Weight gain in the following course of rehabilitation may facilitate positive rehabilitation outcomes.
Assuntos
Lesões Encefálicas/enfermagem , Lesões Encefálicas/reabilitação , Desnutrição Proteico-Calórica/enfermagem , Desnutrição Proteico-Calórica/reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/enfermagem , Redução de Peso , Adolescente , Adulto , Idoso , Estudos de Coortes , Nutrição Enteral/enfermagem , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral/enfermagem , Estudos Prospectivos , Centros de Reabilitação , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
The purpose of this exploratory pilot study was two-fold: (a) to determine the reliability of the instrument to measure nurses' knowledge of artificial nutrition and hydration, and (b) to assess home healthcare nurses' knowledge of artificial nutrition and hydration. A cross-sectional design was used to administer the questionnaire to 91 home healthcare nurses in North Carolina; 33 questionnaires were returned. Results revealed an accurate answer rate of 73% and Cronbach's alpha was 0.71, indicating adequate internal consistency reliability.
Assuntos
Competência Clínica , Hidratação/enfermagem , Enfermeiros de Saúde Comunitária/estatística & dados numéricos , Nutrição Parenteral/enfermagem , Assistência Terminal/métodos , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Assistência Domiciliar/organização & administração , Humanos , Masculino , Projetos Piloto , Inquéritos e Questionários , Resultado do TratamentoRESUMO
There are many guidelines recommending that provision of parenteral nutrition (PN) should be supervised by nutrition support teams (NSTs). There is some evidence that these teams make economic sense, decrease complications and result in greater delivery of target nutritional requirements. Moreover, a recent report on the quality of PN care in the UK found only 19% was considered to be consistent with current good practice. Recommendations exist on how to set up teams, but advice on the practical aspects of doing the job is lacking. In this article, the authors outline the NST method of practice at North Shore Hospital in Auckland, New Zealand, including its assessment sheet and a description of its working acronym LIFEWRAP, which is used to ensure consistent assessment and care.
Assuntos
Desnutrição/enfermagem , Recursos Humanos de Enfermagem Hospitalar/normas , Nutrição Parenteral/enfermagem , Nutrição Parenteral/normas , Equipe de Assistência ao Paciente/normas , Adulto , Humanos , Desnutrição/terapia , Nova Zelândia , Auditoria de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Guias de Prática Clínica como Assunto , Desenvolvimento de ProgramasAssuntos
Nutrição Parenteral/enfermagem , Desnutrição Proteico-Calórica/enfermagem , Adulto , Criança , Desenho de Equipamento , Humanos , Avaliação em Enfermagem , Avaliação Nutricional , Nutrição Parenteral/instrumentação , Soluções de Nutrição Parenteral , Guias de Prática Clínica como Assunto , Desnutrição Proteico-Calórica/prevenção & controle , SuíçaRESUMO
BACKGROUND: Children with intestinal failure (IF) have frequent catheter-related bloodstream infections (CRBSIs). The purpose of this study was to prospectively study the clinical course of CRBSIs and to seek modifiable risk factors for CRBSIs in children with IF. MATERIALS AND METHODS: Children with IF were enrolled prospectively and data on potential risk factors collected monthly. Additional data were collected when they had CRBSIs. RESULTS: Sixteen children were enrolled, yielding 223 months of data. The rate of CRBSIs was 4.6 per 1000 catheter days. The most consistent symptom at onset of CRBSI was fever (28 of 32 cases). Elevated C-reactive protein (CRP) was the only laboratory abnormality that was consistently associated with the onset of CRBSI (elevated in 15 of the 18 cases where it was measured). Combining all episodes in the cases that relapsed, the catheter salvage rate was 17 of 29 (59%), including 4 of 11 polymicrobial CRBSIs. Risk factors for CRBSI included double lumen tunneled central venous catheter (CVC), jugular placement of CVC, higher doses of intralipid, and having <50 cm small bowel postresection. CONCLUSION: The diagnosis of CRBSI should be questioned in the absence of fever and/or elevated CRP. Salvage of catheters should be attempted with all bacterial CRBSIs, assuming that the child is stable since the CVC can be retained in the majority of cases.
Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Enteropatias/enfermagem , Nutrição Parenteral/métodos , Bacteriemia/etiologia , Bactérias/isolamento & purificação , Proteína C-Reativa/análise , Infecções Relacionadas a Cateter/complicações , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/terapia , Cateteres de Demora/microbiologia , Criança , Pré-Escolar , Feminino , Febre/etiologia , Humanos , Incidência , Lactente , Recém-Nascido , Enteropatias/complicações , Intestinos/fisiopatologia , Masculino , Nutrição Parenteral/enfermagem , Estudos Prospectivos , Fatores de RiscoRESUMO
Parenteral nutrition is a recognised method of feeding patients with specific clinical conditions, most notably those with various forms of intestinal failure who cannot be fed enterally. However, it has several associated risks including sepsis, and metabolic and electrolyte imbalances. The aim of this article is to enhance nurses' understanding of parenteral nutrition and how this differs from oral or enteral nutrition, indications for use and the potential risks involved. Appropriate vascular access is discussed as well as the clinical monitoring that is required to ensure complications of therapy are detected quickly. A greater understanding of the issues associated with parenteral nutrition allows nurses caring for patients receiving parenteral nutrition to ensure safe and effective care.
Assuntos
Nutrição Parenteral/enfermagem , Cateteres Venosos Centrais , Desenho de Equipamento , Feminino , Humanos , Pseudo-Obstrução Intestinal/diagnóstico , Pseudo-Obstrução Intestinal/terapia , Pessoa de Meia-Idade , Monitorização Fisiológica , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/métodos , Seleção de PacientesRESUMO
Malnutrition in the UK is estimated to affect 3 million people in the UK, costing the economy pound 13 billion a year. The effects can adversely affect an individual's wellbeing by exacerbating illness or reducing the prospect of a speedy recovery. The early identification of this actual or potential risk is recognised by using a validated nutritional screening tool as part of the patient assessment. Where risks are identified a structured plan should be put in place utilising oral and enteral techniques in nutritional support. However, for a number of patients these routes of feeding may not be an option, or may not fully meet the patient's nutritional requirements. It is in these circumstances that parenteral feeding may be considered under the supervision of a nutrition team. The careful selection of the parenteral solution alongside the most appropriate venous device to deliver the nutrition can assist in the effectiveness of this treatment and help in reducing the potential complications associated with this route.
Assuntos
Desnutrição/enfermagem , Nutrição Parenteral/enfermagem , Humanos , Desnutrição/diagnóstico , Apoio Nutricional , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/métodosRESUMO
The aim of this study was to evaluate whether pediatric bone marrow transplant (BMT) patients receive the prescribed dose of nutrition support (NS). Data were obtained from electronic and paper charts at St. Jude Children's Research Hospital. The amount of NS received was compared with the amount prescribed. Data were collected on 32 patients for 63 hospital stays in which NS was administered. The mean percentage of nutrition prescription met and percentage of total estimated energy met were 69% and 72%, respectively. Allogeneic BMT patients received significantly more of their nutrition prescription (92%) than autologous BMT patients did (54%, P < .01). Malnourished patients were significantly more likely to receive the full dose of NS than patients who were considered nourished or obese (P < .05). This study showed that patients who were most in need of NS were more likely to receive the full dose.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Transtornos da Nutrição Infantil/prevenção & controle , Nutrição Enteral/enfermagem , Auditoria de Enfermagem , Nutrição Parenteral/enfermagem , Criança , Transtornos da Nutrição Infantil/etiologia , Pré-Escolar , Pesquisa em Enfermagem Clínica , Feminino , Humanos , Masculino , Avaliação Nutricional , Necessidades Nutricionais , Estudos Prospectivos , Transplante Autólogo , Transplante HomólogoRESUMO
Hidrotórax secundário à infusão de nutrição parenteral é uma condição rara, embora se apresente cada vez mais comum. Neste relato de caso, uma paciente com síndrome do intestino curto desenvolveu instabilidade hemodinâmica e insuficiência respiratória algumas horas após o início da infusão de nutrição parenteral. Ressaltamos também as manobras para evitar e tratar tal complicação.
Hydrothorax due to parenteral nutrition infusion is a rare, although increasingly common event. This report shows a short bowel patient who developed hemodynamic instability and respiratory failure few hours after parenteral nutrition infusion's start. We also emphasize the maneuvers to avoid and treat such complication.
Assuntos
Humanos , Feminino , Nutrição Parenteral/enfermagem , Síndrome do Intestino Curto/dietoterapia , Hidrotórax , Insuficiência Respiratória/complicaçõesRESUMO
Nocardia farcinica is an emerging pathogen in immunocompromised hosts. Even though several species of Nocardia have been reported as causative pathogens of catheter-related blood stream infections (CRBSI), CRBSI caused by N. farcinica has not been reported. A 70-yr-old man with a tunneled central venous catheter (CVC) for home parenteral nutrition was admitted with fever for two days. Norcardia species was isolated from the blood through CVC and peripheral bloods and identified to N. farcinica by 16S rRNA and rpoB gene sequence analyses. This report emphasizes the rapid and correct identification of causative agents in infectious diseases in the selection of antimicrobial agents and the consideration of catheter removal.