Global availability of parenteral nutrition: Pre- and post-COVID-19 pandemic surveys.

OBJECTIVE: Parenteral nutrition represents a therapeutic option for patients with type 3 intestinal failure. If used exclusively, parenteral nutrition has to be complete to provide all essential nutrients. The aim was to assess the availability of parenteral nutrition in all parts of the world, to better comprehend the global situation, and to prepare an action plan to increase access to parenteral nutrition. METHODS: An international survey using an electronic questionnaire was conducted in August 2019 and repeated in May 2022. An electronic questionnaire was sent to 52 members or affiliates of the International Clinical Nutrition Section of the American Society for Parenteral and Enteral Nutrition. Questions addressed the availability of parenteral nutrition admixtures and their components, reimbursement, and prescribing pre- and post-COVID-19 pandemic. All participating countries were categorized by their economic status. RESULTS: Thirty-six country representatives responded, answering all questions. Parenteral nutrition was available in all countries (100%), but in four countries (11.1%) three-chamber bags were the only option, and in six countries a multibottle system was still used. Liver-sparing amino acids were available in 18 (50%), kidney-sparing in eight (22.2%), and electrolyte-free in 11 (30.5%) countries (30.5%). In most countries (n = 28; 79.4%), fat-soluble and water-soluble vitamins were available. Trace elements solutions were unavailable in four (11.1%) countries. Parenteral nutrition was reimbursed in most countries (n = 33; 91.6%). No significant problems due to the coronavirus pandemic were reported. CONCLUSIONS: Despite the apparent high availability of parenteral nutrition worldwide, there are some factors that may have a substantial effect on the quality of parenteral nutrition admixtures. These shortages create an environment of inequality.

Clinical nutrition and human rights. An international position paper.

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.

Clogbusting: time for a concerted approach to catheter occlusions?

PURPOSE OF REVIEW: Occlusions of central venous catheters in service are frequent, but the random nature of the problem has resulted in a piecemeal approach to solving it. The purpose of this review is to examine what is known from past and recent publications and to recommend strategies for future investigations. RECENT FINDINGS: Long-term central venous access is a critical part of nutritional support for many patients with intestinal failure. The technique also has wide applicability in oncology, the management of certain types of infections and in organ failure. The causes of occlusion have been found to be multifactorial, including a combination of mechanical obstruction, chemical precipitation, lipid deposition and thrombus formation. Most unblocking strategies have been aimed at cure rather than prevention, and targeted at individual causes of obstruction. The British Pharmaceutical Nutrition Group and home parenteral nutrition patients group (Patients on Intravenous and Nasogastric Nutrition Therapy), member organizations of the British Association for Parenteral and Enteral Nutrition, have recently charged a subcommittee with targeting future research into a more concerted practical and pharmaceutical approach to the phenomenon. SUMMARY: Catheter occlusion is a common problem costing considerable time and money for patients and healthcare professionals, requiring pro-action rather than reaction. None of the existing approaches is a complete answer, and further, coordinated research effort is needed. Endoluminal brushing is gradually gaining acceptance as a 'catch-all' solution once the catheter malfunctions, but understanding how and why catheters become blocked, and developing strategies to prevent occlusion would be a more scientific approach.