[Catheter occlusion and venous thrombosis prevention and incidence in adult home parenteral nutrition (HPN) programme patients]. / Prevención e incidencia de oclusión del catéter y trombosis venosa en pacientes adultos con nutrición parenteral domiciliaria (NPD).

UNLABELLED: In adult home parenteral nutrition (HPN) programme patients up to now no evidence-based recommendations exist on the central venous catheter maintenance nor venous thrombosis prevention. The use of heparin flushes could be linked with long term complications, besides, anticoagulants use is controversial. OBJECTIVES: To be aware of the usual maintenance practice for HPN central venous catheters, catheter occlusion and related venous thrombosis incidence in our country. METHODS: Retrospective study of active HPN patients older than 18 years registered by the NADYA- SENPE working group until November 2008. RESULTS: 49 patients were registered (16 males and 33 females), with an average age of 52.1 ± 13.9 years, belonging to 6 hospitals. HPN length was 57.4 ± 73.3 months with 5.8 ± 1.8 PN days a week. The most frequent pathologies were actinic enteritis, intestinal motility disorders and mesenteric ischemia (20.4% each), and neoplasm (16.3%). The reason for HPN provision was short bowel syndrome (49.0%), and intestinal obstruction (28.6%). Neoplasm (16.3%), thrombotic diathesis, thromboembolic syndrome and bed rest (6.1% each) were the main venous thrombosis adjuvant factors. Tunnelled catheters were used in 77.6% of patients, with implanted port-catheters in the remainder. Maintenance of the line was done with saline solution flushes (28.6%) and different concentrations of heparin solutions (69.4%). When heparin was used, it was removed before PN infusion in 63.3% of patients. Catheter occlusion and venous thrombotic events rates were 0.061/10³ and 0.115/10³ HPN days respectively. Eleven patients (22.4%) were treated with anticoagulant drugs due to previous episodes of venous thrombosis or pulmonary embolism. CONCLUSION: [corrected] The incidence of catheter related thrombotic complications incidence is low in this group of patients on HPN. There is a great variety of practices focused on the prevention of both: line occlusion and catheter related venous thrombosis. In conclusion, it would be necessary to standardize practice.

[Home enteral nutrition in Spain: NADYA registry in 2010]. / Nutrición enteral domiciliaria en España: registro NADYA del año 2010.

OBJECTIVE: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2010. MATERIAL AND METHODS: We retrieved the data of the patients recorded from January 1st to December 31st 2010. RESULTS: We registered 6,591 patients (51% males) with 6,688 episodes of HEN, from 32 hospitals. Mean age in those younger than 14 yr (4%) was 1 ± 2 yrs (m ± SD) and 69,9 ± 17,8 yrs in those older than 14 yr. The length of HEN was longer than 2 yrs in 76% of the patients. The most frequent underlying disease was neurological disorders 42%, followed by cancer 28% (mostly head and neck cancer 18%). We had information related to the enteral access route in only 626 cases (9,4%), 51% of them used nasogastric tubes, 27% gastrostomies, 10% oral route and 3% jejunostomies. Only 251 episodes were closed during the year, mostly due to patient death 57% and progress to oral diet 14%. The activity level was limited in 29% of the patients and 39% of them were bed- or chairridden. Total or partial help was needed by 68% of the patients. The hospitals and the private pharmacies delivered the enteral formula in 63% and 34% of the cases, respectively. The hospitals and the primary care centres delivered the disposables in 83% and 16% of the cases, respectively. CONCLUSIONS: The results of the 2010 HEN registry are similar to those published in previous years regarding the number and characteristics of the patients. We continue finding problems in the entrance of data referred to the enteral access route and the closing of the episodes.

[Home Parenteral Nutrition (HPN) registry in Spain for the years 2007, 2008 and 2009 (NADYA-SENPE Group)]. / Registro de la Nutrición Parenteral Domiciliaria (NPD) en España de los años 2007, 2008 y 2009 (Grupo NADYA-SENPE).

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2007, 2008 and 2009. METHODOLOGY: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st 2007 to December 31st 2009. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: 2007: 133 patients with HPN were registered (61 males and 72 females), belonging to 21 hospitals. Average age for the 119 patients older than 13 years old was 53.7 ± 14.9 years, and 3.6 ± 3.6 y. for the 14 patients under 14 years old. Most frequent pathology was neoplasm (24%), followed by intestinal motility disorders and actinic enteritis (14% both). The reason for HPN provision was short bowel syndrome (43%), malabsorption (27%), and intestinal obstruction (23%). Tunnelled catheters were mostly used (69%), followed by implanted port-catheters (27%). Catheter related infections were the most frequent complications, with a rate of 0.92 episodes/103 HPN days. HPN was provided for more than two years in 50% of the cases. By the end of 2007, 71.4% of the patients remained active; exitus was the most frequent reason to end HPN (57.5%). 26% of the patients were eligible for intestinal transplant. 2008: 143 patients with HPN were registered (62 males and 81 females), belonging to 24 hospitals. Average age for the 133 patients older than 13 years old was 54.7 ± 13.9 years, and 3.7 ± 0.6 y. for the 10 patients under 14 years old. Most frequent pathology was neoplasm (20%), followed by actinic enteritis (14%) and intestinal motility disorders (13% ). The reason for HPN provision was short bowel syndrome (44%), malabsorption (28%), and intestinal obstruction (20%). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (29%). Catheter related infections were the most frequent complications, with a rate of 0.50 episodes/10³ HPN days. HPN was provided for more than two years in 67% of the cases. By the end of 2008, 71.6% of the patients remained active; exitus was the most frequent reason to end HPN (52.4%). 29% of the patients were eligible for intestinal transplant. 2009: 158 patients with HPN were registered (62 males and 96 females), belonging to 24 hospitals. Average age for the 149 patients older than 13 years old was 55.2 ± 13.0 years. Most frequent pathology was neoplasm (25%), followed by actinic enteritis (12%) and intestinal motility disorders (11%). The reason for HPN provision was short bowel syndrome (42%), malabsorption, and intestinal obstruction (23% both). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (36%). Catheter related infections were the most frequent complications, with a rate of 0.67 episodes/10³ HPN days. HPN was provided for more than two years in 58% of the cases. By the end of 2009, 79.2% of the patients remained active; full oral nutrition was the most frequent reason to end HPN (48%). 23% of the patients were eligible for intestinal transplant. CONCLUSIONS: We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections in the last two years, being the 2008 rate the smallest since the register's beginning.

[Spanish home enteral nutrition (HEN) registry of the year 2008 from the NADYA-SENPE group]. / Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España en el año 2008.

AIM: To present the results of the Spanish home enteral nutrition (HEN) registry of the year 2008 from the NADYA-SENPE group. MATERIAL AND METHODS: We recorded the HEN registry data from January 1st to December 31st 2008. RESULTS: The number of patients registered in this period was 6206 (51% male) with up to 6,279 episodes of HEN, from 31 Spanish hospitals. Most of the patients (95%) were older than 14 yr. Mean age was 4.83±3.29 yr in the children group, and 70.75±18.14 yr in the adult group (older than 14 yr). Neurological disorders (39%) and cancer (27%) were the two most prevalent diagnoses. The oral route was the most frequently used (43,4%), followed by nasogastric tube (40,4%), and gastrostomy tube (14,7%). Mean length of treatment was 305,36 days (10 months). The principal reasons for discontinuing treatment were death (43%) and progress to oral diet (40%). Only 33% of the patients had a normal activity level, being limited in different grades in the rest of the patients. Most of the patients required partial (25%) or total help (38%). The enteral formula was provided by the hospital in 65% of the cases and by private pharmacies in 32%. The disposables were provided by the hospital (82,4%) and primary care services (17,2%). CONCLUSIONS: The number and the age of the patients registered have increased comparing to previous years, with little variations in the rest of analyzed variables. The increase in the length of treatment could reflect misreporting of the weaning process in the registry.

[Karnosfsky index as a mortality predicting factor in patients on home-based enteral nutrition]. / El índice de Karnofsky como predictor de mortalidad en pacientes con nutrición enteral domiciliaria.

UNLABELLED: Karnofsky Index (KI) is a widely used functional scale developed for oncology patients. It has proved useful as outcome predictor with cancer and geriatric patients. Theoretically, KI could be used to predict mortality in patients with home enteral nutrition (HEN). STUDY OBJECTIVES: To determine baseline KI and its 6-month evolution in HEN patients, and to assess its relation with the mortality rate. METHODOLOGY: Observational and prospective study carried out during 2002 and 2003 with tube feeding neurologic and cancer patients followed during 10 months since their HEN programme inclusion. RESULTS: 201 patients were included, 131 (65.2%) with neurological diseases and 70 (34.8%) with neoplasm. There were not significant differences between groups in age, days with HEN and mortality rate at the end of the study period (35.1% in neurologic patients and 40% in cancer ones). 27.1% of cancer patients had resumed full oral nutrition after ten months from the beginning of the study, whereas only 10.7% of neurologic patients did (p < 0.05). In the three measurement phases (initial, past-3 and past-6 months) KI values were higher for cancer patients than for neurologic ones (p < 0.001). In both groups we didn't found statistically significant differences in KI along the three measurements. A significant relation was observed overall between initial KI values and average survival after 10 months (p < 0.001), and an inverse relation was found between the former and mortality rate (p < 0.001). CONCLUSION: KI is a useful tool to predict mortality rate in cancer and neurologic patients under HEN.

Evolution of lipid profile, liver function, and pattern of plasma fatty acids according to the type of lipid emulsion administered in parenteral nutrition in the early postoperative period after digestive surgery.

BACKGROUND: The metabolic effects of intravenous lipid emulsions (ILEs) used in parenteral nutrition (PN) depend on their fatty acid composition. METHODS: Subjects in this prospective and randomized double-blind study were 28 adult patients post digestive surgery. PN was started after surgery and lasts for 5 days. Randomly, patients receive 1 of 4 different ILEs: medium-chain triglycerides/long-chain triglycerides (soybean oil; MCT/LCT), olive/soybean oil (oleic), long-chain triglycerides (soybean oil; LCT), and structured lipid. On days 0 and 6, serum liver function tests were analyzed for cholesterol, triglycerides, lipoproteins, and serum fatty acids. RESULTS: No differences were found in the 4 groups according to their gender, age, body mass index, diagnosis, baseline white blood cell, C-reactive protein, glucose levels, and other study parameters. Differential significant changes were not observed in any of the hepatic function parameters or plasmatic lipid levels between the groups. A significant decrease was observed in cis monounsaturated fatty acids (MUFAs) and a significant increase in omega-6 polyunsaturated fatty acids (PUFAs) and omega-3 PUFA values in LCT and structured groups compared with MCT/LCT and oleic groups, and a tendency for a decrease in trans fatty acids in the oleic and structured groups was found. CONCLUSIONS: All ILEs administered were safe and well tolerated. The changes in serum fatty acids reflected the pattern of fatty acids administered with different ILEs. The group receiving the olive oil emulsion achieved a fatty acid composition of serum lipids that could offer major therapeutic or biological advantages.

[Spanish Registry of Home-based Parenteral Nutrition during 2006 (NADYA-SENPE Group)]. / Registro de la Nutrición Parenteral Domiciliaria (NPD) en España del año 2006 (Grupo NADYA-SENPE).

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the year 2006. METHODOLOGY: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st to December 31st 2006. RESULTS: 103 patients with HPN were registered (47 males and 56 females), belonging to 19 hospitals. Average age for the 91 patients older than 14 years old was 53.3 +/- 14.9 years old, and that for the 12 patients under 14 years old was 2 +/- 0 years old. Most frequent pathology was neoplasm (29%), followed by intestinal motility disorders (13%). The reason for HPN provision was short bowel syndrome (40%), intestinal obstruction (22%), and malabsorption (21%). Tunneled catheters were mostly used (45%), followed by implanted port-catheters (32%). Catheter related infections were the most frequent complications, with a rate of 0.85 episodes / 10(3) days. HPD was provided for more than two years in 50% of the cases. By the end of 2006, 70.9% of the patients remained active; exitus was the most frequent reason to end HPN (53%). Complementary oral or enteral nutrition was provided to 52% of the patients. 48% of the patients had a normal activity level, and a 55% were autonomous. PN formula was supplied by the hospital in 82% of the cases, while this number was 78% for fungible materials. 27% of the patients were eligible for intestinal transplant. CONCLUSIONS: We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections with respect to the 2004-2005 period.

Guidelines for colorectal cancer: effects on nutritional intervention.

INTRODUCTION: Although parenteral nutrition is a vital method of delivery essential nutrients in patients with malnutrition associated to gastro-intestinal insufficiency, its inappropriate use can increase the risk of complications and incur unnecessary expenses. OBJECTIVE: Our goal was to evaluate the influence of both, the presence of the Nutritional Support Unit and the implementing clinical practice guidelines on post-operative nutritional status, complications and length of stay among patients undergoing elective colorectal cancer surgery. METHODS: Prospective and observational study: Three period times were included-the year during the guidelines elaboration (A), and the first (B) and the second year (C) after their implementation. All patients submitted to elective colorectal cancer surgery at least 18 years of age were included (A: n=297; B: n=103, and C: n=149). WE ANALYSED: Nutritional status (NS) on admission to hospital and at discharge, use of post-operative parenteral nutrition (PPN), incidence of post-operative complications (PC), number of days of nil by mouth following surgery (NPO), and hospital length of stay (LOS). RESULTS: Although the prevalence of malnutrition on admission was low, an increment was observed during the hospitalisation time. However, only in the first period time, the increment was significantly different (A: from 8.4% to 19.5%, p<0.001; B: from 3.9% to 8.7%, and C: from 4.7% to 6.7%). Globally, the use of PPN decreased (A: 79.1%, B: 47.0%, and C: 12.8%; p<0.001). This behaviour was mainly observed in well-nourished patients (use of PPN in well nourished, A: 79.3%, B: 44.4%, and C: 11.3%; p<0.001). Significant differences were observed in the global incidence of PC (A: 27.9%, B: 28.2%, and C: 8.1%, p<0.001). Furthermore, PC was higher in well-nourished patients with PPN versus without PPN, with significant differences in B and C periods (A: 29.3% vs. 25.0%; B: 38.6% vs. 18.8%, p=0.004; C: 31.3% vs. 4.8%, p=0.003). The NPO was higher in patients without PPN in period A (7 d vs. 5 d, p<0.001) and higher in those with PPN in period C (8 d vs. 6 d, p=0.035). All in all, LOS decreased significantly during the study period time (A: 16 d, B: 13 d, and C: 11 d, p<0.001). CONCLUSION: The presence of Nutritional Support Unit and clinical practice guidelines for colorectal cancer management and treatment, optimised the use of hospital resources, namely unnecessary use of parenteral nutrition, reduction along with decrease in number of complications and length of hospital stay.

[Contribution of nutritional support to fight cancer cachexia]. / Contribución del soporte nutricional a combatir la caquexia cancerosa.

To increase dietary intake and to fight anorexia several measures to treat symptoms and administer the most adequate diet according to composition, texture and flavour are proposed. However, in the anorexia-caquexia present in cancer patients not always these measures are effective. Now a day it seems more reasonable to approach this problem with different strategies directed to modulate the pathologic alterations associated. The analysis of specific nutritional support as part as the treatment of these patients from a systematic review conclude that no high methodological quality studies to analyze the impact of oral supplementation on a specific group of patients, neither the study of functional effects are done. However, an increase in the total energy intake, not maintained over the time, was observed. The effects on weight and corporal composition are variable, with small differences between groups with o without supplementation and confuse due to, mainly, the heterogeneity of the patients included in the different studies analyzed. The analysis of the effects of nutritional supplements administered by enteral feeding shown an increase in the energy intake with an increase in body weight or a lack of decrease it, and with some functional and clinical beneficial effects. Despite the results and conclusions obtained, a strong recommendation to conduct clinical trials in specific group of cancer patients with different antineoplasic treatment seems necessary. N-3 fatty acids, especially eicosapentaenoic acid may have anticachectic properties. Although further trials are necessary the limited results available suggests that nutritional supplements enriched with EPA may reverse cachexia in cancer patients.

Nutritional status among adult patients admitted to an university-affiliated hospital in Spain at the time of genoma.

BACKGROUND: Although malnutrition in hospitalized patients is generally associated with increasing morbidity and mortality, it is yet a widely unknown problem in hospitals. OBJECTIVES: The aim of this study was to assess the nutritional status of patients admitted to a university-affiliated hospital in Spain using anthropometry measurements and the Subjective Global Assessment (SGA) technique. METHODS: We enrolled 400 patients selected at random using a computer software program. The primary end-point was nutritional status determined within 48 h of admission by anthropometric data (body mass index, triceps skinfold thickness, and upper arm muscle circumference) and by the SGA technique. Using anthropometric data, patients were considered to have normonutrition or malnutrition. Those with malnutrition, were subdivided in patients with low (undernutrition) or high (overnutrition) body weight. Through SGA patients were classified as having normonutrition or malnutrition (moderate and severe). Secondary end-points were hospital length of stay (LOS), mortality, and readmissions (total and non-elective readmissions) over the next 6 months. Overall population, patients scheduled admitted, patients admitted from emergency room, and those with any cancer were individually analyzed. RESULTS: The frequency of malnutrition varied from 72.7% assessed by anthropometry (undernutrition in 26.7% and overnutrition in 46.0%), to 46% using SGA. Malnutrition was not related to the type of admission neither to the diagnosis of cancer. Of 400 patients analyzed, two patients died (0.5%). Using SGA, LOS was significantly higher in patients with malnutrition vs. those with normonutrition, in the overall population and in patients scheduled admitted, and there were more total and non-elective readmissions in patients with malnutrition than in patients with normonutrition in the overall population, in patients scheduled admitted and in those with cancer. When we used anthropometric data, LOS was superior in undernutrition compared to normo and overnutrition in scheduled admitted patients alone. Although there were more total readmissions in undernutrition than in normonutrition and overnutrition in overall population, no significant differences were observed with the non-elective readmission rate. CONCLUSIONS: A high prevalence of malnutrition was found in this study. At a time, a high prevalence of overnutrition was observed. Anthropometric data and SGA technique are not concordant, reflecting the limitations of markers of nutritional status. While with SGA malnutrition was detected in patients with normal to high BMI, with anthropometry overnutrition was diagnosed. SGA seems to be more accurate than anthropometry to anticipate hospital LOS and readmission rate. Due to the increased LOS and readmission rates found in patients with malnutrition, further steps among health care professionals are warranted to identify and control them.