Liver function test alterations associated with parenteral nutrition in hospitalized adult patients; incidence and risk factors / Alteraciones de los parámetros hepáticos asociados con la administración de nutrición parenteral en pacientes adultos hospitalizados; incidencia y factores de riesgo

Background: Parenteral nutrition-associated liver dysfunction can be progressive and irreversible, particularly in children and patients with long-term treatment. This study has assessed the incidence of abnormal liver function tests in hospitalized adults during short term parenteral nutrition (PN) and has investigated risk factors for developing alterations of each parameter. Methods: A prospective cohort study of parenteral nutrition treated patients with preserved liver function at baseline. Variables examined included nutritional and clinical data and laboratory parameters. Determinations were performed before starting PN and weekly until liver function test alteration was observed. Risk factors were investigated by four stepwise forward logistical regressions. Results: Eighty patients were included, 57.5% had liver function test alterations. PN mean duration was 15.9 (8-54) days. Mean days with PN and additional enteral/ oral nutrition were 1.5 (0-20). The following associations were found: gamma-glutamyl-transferase increased with soybean lipid intake and absolute diet; alkaline phosphatase increased with septic shock; alanine transaminase increased with septic shock, hyperglycemia and elevated creatinine; total bilirubin increased with septic shock, absolute diet, low prealbumin and glucose, and high creatinine. Conclusions: The incidence of altered liver function tests is high in adult hospitalized patients treated with short-term PN. However, the effect of nutritional factors in this alteration is low. Oral/enteral nutrition and reduction of soybean lipid supply can reduce increases in some liver function tests such as gamma-glutamyl-transferase and total bilirubin. The high association between all liver function tests and clinical systemic-hypermetabolic variables suggest the importance of specific nutritional strategies for this condition (AU)

Introducción: La alteración hepática asociada a la nutrición parenteral (NP) puede ser progresiva e irreversible particularmente en niños y en tratamientos de larga duración. El objetivo de este estudio es establecer la incidencia de las alteraciones de los parámetros hepáticos en pacientes adultos hospitalizados en tratamiento con NP y estudiar los factores de riesgo asociados al desarrollo de las alteraciones de cada uno de los parámetros hepáticos. Métodos: Estudio prospectivo de cohortes de los pacientes tratados con NP con función hepática normal al inicio del tratamiento. Se estudiaron parámetros clínicos, nutricionales y analíticos. Las determinaciones se hicieron antes de iniciar la nutrición y semanalmente hasta que se detectó la alteración de algún parámetro hepático. Los factores de riesgo asociados a la alteración hepática se estudiaron con 4 regresiones logísticas. Resultados: Se incluyeron 80 pacientes y 57,5% mostraron alteraciones hepáticas. La media de duración de la NP fue 15,9 días (8-54) y la media de días con nutrición enteral u oral concomitantes fue de 1,5 (0-20). Se encontraron las siguientes asociaciones: la gamma-glutamil-transferasa aumentaba con la cantidad de lípidos de soja administrados y los días en dieta absoluta; la fosfatasa alcalina con el shock séptico, la alanina-aminotransferasa con el shock séptico, la hiperglucemia y los valores elevados de creatinina; la bilirrubina total con el shock séptico, la dieta absoluta, valores bajos de prealbúmina y glucosa; y valores altos de creatinina. Conclusiones: La incidencia de alteraciones de los parámetros hepáticos es elevada en pacientes adultos hospitalizados tratados con NP, aunque el efecto de los factores nutricionales en esta alteración es bajo. La nutrición oral/enteral y la reducción de los lípidos en forma de soja pueden reducir el aumento de algunos parámetros hepáticos como la gamma-glutamiltransferasa y la bilirrubina total. La gran asociación entre todos los parámetros hepáticos y las variables sistémicas indicadoras de hiper-metabolismo apuntan a la importancia de las estrategias nutricionales específicas en esta situación (AU)

Nutrición parenteral modular: ¿un nuevo concepto? / Modular parenteral nutrition: a new concept?

Introducción: Definimos Nutrición Parenteral Modular (NPM) como las mezclas de nutrición parenteral (NP) obtenidas a partir de la adición de diferentes macronutrientes a preparados estándar (NPE) tanto binarios (aminoácidos y glucosa) como ternarios (aminoácidos, lípidos y glucosa). Objetivos: El objetivo de este estudio es demostrar que utilizando la NPM se pueden ajustar las fórmulas de NP a las necesidades individuales de cada paciente y disminuir la carga de trabajo. Material y métodos: Estudio retrospectivo de casos y controles de las NP preparadas durante el primer semestre de los años 1995, 2000 y 2005. Las NP se subdividen en: estándar (NPE) —dispensadas sin manipular—, individualizadas (NPI) y modulares. Se comparan los protocolos en los diferentes periodos, y para evaluar la carga de trabajo se relaciona el volumen de fluido trasvasado con el volumen total preparado. Se aplican los tests de chi cuadrado y t de Student con significación para p < 0,05. Resultados: En 1995 prácticamente sólo se utilizaban fórmulas individualizadas. En el año 2000 se introdujeron NPE y NPM para las fórmulas de mantenimiento y las de estrés moderado. Finalmente, en el año 2005 se ha incluido el concepto modular para fórmulas de estrés severo y/o inmunomoduladoras. Como consecuencia de estos cambios, en el protocolo se observa una disminución de las NPI debido a la introducción progresiva de las NPM. En 1995 la NPM representaba un 2,6% del total de elaboraciones, aumentando a un 64,7% en el 2000 y a un 74,7% en el 2005. Este hecho se ha traducido en una disminución en el volumen trasvasado a través del sistema volumétrico de elaboración. En 1995 se trasvasó el 87,3% del volumen total, en el 2000 el 34,3% y finalmente en el 2005 pasó a ser sólo de un 20,6% (diferencias estadísticamente significativas entre los tres periodos; p < 0,05). En el año 2005 se elaboraron 543 NPI, de las cuales 169 (31,1%) fueron para pacientes con encafalopatía hepática o con insuficiencia renal aguda no dializados. A las NPM elaboradas durante este mismo periodo, se ha incorporado: glutamina, emulsiones lipídicas de aceite de pescado, lípidos estructurados, lípidos de patrón de oliva, soluciones poliiónicas y micronutrientes específicos. Discusión: La NPM permite adecuar las fórmulas de NP a un amplio abanico de situaciones clínicas, aunque en determinadas patologías siguen siendo imprescindibles las formulaciones individualizadas. La utilización de NPM se traduce en una disminución de fórmulas individualizadas que se refleja en una menor carga de trabajo

Introduction: We may define Modular Parenteral Nutrition (MPN) as parenteral nutrition (PN) mixtures obtained from adding different macronutrients to standard formulations (SPN) both binary (amino acids and glucose) and ternary (amino acids, lipids, and glucose). Objectives: The aim of this study is to demonstrate that PN formulations may be adapted to individual needs of each patient and workload may be reduced by using MPN. Material and methods: Case-control retrospective study of PN prepared during the first semester of the years 1995, 2000, and 2005. PN are categorized in: standard (SPN) —given without manipulation—, individualized (IPN), and modular parenteral nutrition (MPN). The protocols are compared at the different periods, and the volume of transferred fluid is related with total prepared volume in order to calculate the workload. The Chi squared and student’s t tests with a significance level of p < 0.05 are used. Results: In 1995, virtually only individualized formulations were used. In the year 2000, SPN and MPN were introduced as maintenance formulas as well as those for moderate stress. Finally, in the year 2005, the modular concept has been introduced for severe stress and/or immunomodulatory formulas. As a result of these changes, we observe in the protocol a decrease in IPN due to progressive introduction of MPN. In 1995, MPN represented 2.6% of all elaborations, increasing up to 64.7% in 2000, and to 74.7% in 2005. This fact has resulted in a decrease in transferred volume through the volumetric elaboration system. In 1995, 87.3% of the total volume was transferred, in the year 2000 34.3%, and finally in 2005 only 20.6% (the differences between the three periods are statistically significant; p < 0.05). In the year 2005, 543 IPN were elaborated, of which 169 (31.1%) were for patients with liver encephalopathy or non-dialyzed acute renal failure. The following ingredients have been added to MPN during that same period: glutamine, fish oil lipid emulsions lipídicas, structured lipids, olive-pattern lipids, polyionic solutions, and specific micronutrients. Discussion: MPN allows for adapting PN formulas to a wide range of clinical situations, although individualized formulations still are irreplaceable for some pathologies. The use of MPN is associated with a decrease in individualized formulas that reflects in lower workload

[Modular parenteral nutrition: a new concept?]. / Nutrición parenteral modular: un nuevo concepto?

INTRODUCTION: We may define Modular Parenteral Nutrition (MPN) as parenteral nutrition (PN) mixtures obtained from adding different macronutrients to standard formulations (SPN) both binary (amino acids and glucose) and ternary (amino acids, lipids, and glucose). OBJECTIVES: The aim of this study is to demonstrate that PN formulations may be adapted to individual needs of each patient and workload may be reduced by using MPN. MATERIAL AND METHODS: Case-control retrospective study of PN prepared during the first semester of the years 1995, 2000, and 2005. PN are categorized in: standard (SPN) -given without manipulation-, individualized (IPN), and modular parenteral nutrition (MPN). The protocols are compared at the different periods, and the volume of transferred fluid is related with total prepared volume in order to calculate the workload. The Chi squared and student's t tests with a significance level of p < 0.05 are used. RESULTS: In 1995, virtually only individualized formulations were used. In the year 2000, SPN and MPN were introduced as maintenance formulas as well as those for moderate stress. Finally, in the year 2005, the modular concept has been introduced for severe stress and/or immunomodulatory formulas. As a result of these changes, we observe in the protocol a decrease in IPN due to progressive introduction of MPN. In 1995, MPN represented 2.6% of all elaborations, increasing up to 64.7% in 2000, and to 74.7% in 2005. This fact has resulted in a decrease in transferred volume through the volumetric elaboration system. In 1995, 87.3% of the total volume was transferred, in the year 2000 34.3%, and finally in 2005 only 20.6% (the differences between the three periods are statistically significant; p < 0.05). In the year 2005, 543 IPN were elaborated, of which 169 (31.1%) were for patients with liver encephalopathy or non-dialyzed acute renal failure. The following ingredients have been added to MPN during that same period: glutamine, fish oil lipid emulsions lipidicas, structured lipids, olive-pattern lipids, polyionic solutions, and specific micronutrients. DISCUSSION: MPN allows for adapting PN formulas to a wide range of clinical situations, although individualized formulations still are irreplaceable for some pathologies. The use of MPN is associated with a decrease in individualized formulas that reflects in lower workload.

Utilización de glutamina en nutrición parenteral en paciente crítico: efectos sobre la morbi-mortalidad / Glutamine use for parenteral nutritin in the critically ill patient: effects on morbimortality

Objetivos: Determinar la relación entre aditivar dipéptidos de glutamina a la nutrición parenteral (NP) y la morbi-mortalidad en paciente crítico. Material y métodos: Estudio retrospectivo de casos y controles. Como casos se recogieron pacientes a los que se administró NP suplementada con 2 g de nitrógeno (glutamina) durante el período 2001-2004. Los controles fueron pacientes con NP sin glutamina recogidos durante el 2000. Todos los pacientes incluidos presentaban infección definida como la presencia de un foco infeccioso más 2 de los siguientes criterios: leucocitos > 12.000 x 106/L, fiebre > 38 ºC, frecuencia cardíaca > 90 latidos/minuto o PCO2 100 mg/L o fístula. Se excluyeron los pacientes con insuficiencia renal, diálisis previa, encefalopatía hepática o dieta mixta. Las variables de morbi-mortalidad registradas fueron: hiperglucemia, fracaso renal, días con NP, días en UCI, días de hospitalización y mortalidad. Resultados: Se incluyeron 202 pacientes (75 casos y 127 controles). En el estudio univariante previo no aparecieron diferencias significativas para las variables independientes entre los 2 grupos. En el estudio multivariante, la aditivación de glutamina se asoció significativamente a menor incidencia de fracaso renal (OR:0,28; IC:0,08-1,00), menor hiperglucemia (OR:0,38; IC:0,19-0,75), menos días de hospitalización (OR:0,64; IC: 0,44-0,92) y menos días en UCI (OR:0,64; IC: 0,45-0,93). Para la variable exitus, la adición de glutamina mostró tendencia a la inclusión en el modelo (p = 0,097). En cuanto a los días con NP la variable glutamina no se incluyó en modelo Conclusiones: En pacientes críticos, la adición de glutamina a la NP conlleva una recuperación más rápida y menor incidencia de hiperglucemia y fracaso renal. Dados estos resultados, la adición de glutamina a las NP de determinados pacientes es un recurso efectivo para acelerar su recuperación y evitar determinadas complicaciones

Objective: To determine the relationship between adding glutamine dipeptides to parenteral nutrition (PN) and morbimortality in the critically ill patient. Material and methods: Case-control retrospective study. The cases were patients to whom PN supplemented with 2 g of nitrogen (glutamine) was administered during the period 2001-2004. Controls were patients with PN without glutamine, collected during the year 2000. All included patients had infection defined as the presence of an infectious site plus more than two of the following criteria: leucocytes > 12.000 x 106/L, fever > 38 ºC, heart rate > 90 bmp, or PCO2 100 mg/L or a fistula. Patients with renal failure, previous dialysis, hepatic encephalopathy, or mixed diet were excluded from the study. Morbimortality variables collected were: hyperglycemia, renal failure, days on PN, days in the ICU, hospitalization days, and mortality. Results: Two hundred and two patients (75 cases and 127 controls) were included. In the previous univariate analysis no significant differences appeared for independent variables between both groups. In the multivariate analysis, glutamine addition was significantly associated to lower renal failure incidence (OR: 0.28; CI: 0.08- 1.00), lower hyperglycemia (OR: 0.38; CI: 0.19-0.75), less hospitalization days (OR: 0.64; CI: 0.44-0.92), and fewer days in the ICU (OR: 0.64; CI: 0.45-0.93). For the variable “exitus”, glutamine addition showed a trend towards inclusion into the model (p = 0.097). About the days on PN, the variable glutamine was not included into the model. Conclusions: In critically ill patients, adding glutamine to PN leads to quicker recovery and lower incidence of hyperglycemia and renal failure. In view of these results, adding glutamine to PN of particular patients is an effective measure to speed up their recovery and avoid certain complications

Implantación y evaluación del análisis de peligros y puntos de control críticos (APPCC) en las industrias tinerfeñas productoras de Gofio / Implementation and evaluation of critical hazards and check points analysis (chcpa) in gofio-producing industries from Tenerife

Objetivo: Implantar de manera satisfactoria el Sistema de Análisis de Peligros y Puntos de Control Críticos. Ámbito: la Isla de Tenerife. Sujetos: 15 industrias. Intervención: se procedió realizando visitas a las fábricas productoras de gofio, con el fin de asesorar a los empresarios y operarios de las mismas, posteriormente se valoró la intervención verificando condiciones higiénico-sanitarias de la industria y la correcta aplicación del Sistema de Autocontrol establecido. Resultados: Después de la intervención de asesoramiento, se observa que determinados parámetros tenidos en cuenta desde el punto de vista higiénico-sanitario se han corregido, como modificar sus instalaciones para adecuarlas a las normativas vigentes o pedir que los proveedores certifiquen las materias primas. En cuanto al proceso de producción del alimento, la intervención fue efectiva para que más de la mitad de las industrias redujeran el tiempo de aquellas fases más susceptibles de contaminación y para que se llevaran a cabo los de registros de control que se establecieron. Conclusiones: Todas las industrias instauraron el sistema de autocontrol mediante cuadros de registros de cada una de las fases de elaboración. El 86% de las industrias han introducido materiales más higiénicos. Un 60% aplicaron una reducción en los plazos de tiempo intermedios en las fases de producción. Un 26% realizaron alguna sustitución de maquinaria obsoleta, modernizando las instalaciones (AU)

Objective: To satisfactorily implement the critical hazards and check points analysis. Setting: Tenerife Island. Subjects: 15 industries. Intervention: visits to gofio-manufacturing industries were done with the aim of giving advice to employers and workers, and thereafter, the intervention was assessed verifying the hygiene and sanitary conditions of the industry and the correct application of the established auto-control system. Results: After the advising intervention, we observed that certain parameters taken into account from the hygiene and sanitary perspective have been corrected, such as modifying the facilities to adapt them to in force regulations, or asking the suppliers to certify raw materials. With regards to food production process, the intervention was effective in such a way that more than have of the industries reduced the time of those phases with higher contamination susceptibility and to carry out the control registries that were established. Conclusions: All industries implemented the autocontrol system by means of registration charts of each one of the elaboration phases. - 86% of the industries have introduced more hygienic materials. - 60% implemented a reduction in intermediate times of production phases. - 26% performed some obsolete machinery replacement modernizing the facilities (AU)

[Quality of the home parenteral nutrition program: 14 years of experience at a general university hospital]. / Calidad del programa de nutrición parenteral a domicilio: 14 años de experiencia en un hospital general universitario.

The quality of home parenteral nutrition (NPD in its Spanish acronym) depends on the frequency and type of complication associated with NPD treatment and the likelihood of survival. The present study assesses the quality of the NPD programme in place in our hospital in terms of survival, infections and mechanical complications. A retrospective study was carried out into the clinical follow-up data of all the patients (n = 24) included in our NPD programme since its start in 1985 until 1998 (14 years). An estimate is made for: a) the annual index of infectious complications (IAC in its Spanish acronym), b) the annual index of mechanical complications (MAC in its Spanish acronym) and c) the likelihood of survival by means of the Kaplan-Meier method. The quality specifications adopted are those of the literature reflecting the current provision of NPD programmes and the survival values of patients undergoing dialysis for chronic kidney failure. The most frequent pathology in our context is benign (70.8%), distributed as follows: small bowel syndrome of ischaemic origin (45.8%), small bowel syndrome of non-ischaemic origin (12.5%) and idiopathic intestinal pseudo-obstruction (12.5%). The patients with benign pathologies present a higher survival rate than patients with neoplastic disease (95% in the fifth year of treatment versus 45% at twenty months), with a statistically significant difference. The annual index of infectious complications is 0.6 (median value of the 14 years studied). Similarly, the annual indices of obstructions and thromboses are 0.11 and 0.0095, respectively. In our opinion, the quality of the NPD programme in place at our hospital is highly satisfactory because both the survival rate and the annual indices of mechanical and infectious complications are acceptable with regard to the programmes in place in the international sphere. In addition, in terms of survival, NPD seems slightly more effective than dialysis for chronic kidney disease.

Calidad del programa de nutrición parenteral a domicilio 14 años de experiencia en un hospital general universitario / Quality of home parenteral nutrition programme: 14 years's experience at a general teaching hospital

La calidad del tratamiento con nutrición parenteral a domicilio (NPD) depende de la frecuencia y tipo de complicaciones asociadas al mismo, así como de la probabilidad de supervivencia. En este trabajo se evalúa la calidad del programa de NPD existente en nuestro hospital en términos de supervivencia, complicaciones infecciosas y complicaciones mecánicas. Se realiza un estudio retrospectivo de los datos del seguimiento clínico de todos los pacientes (n = 24) incluidos en el programa de NPD de nuestro centro desde su inicio en 1985 hasta 1998 (14 años). Se estiman: a) el índice anual de complicaciones infecciosas (IAC), b) el índice anual de complicaciones mecánicas (MAC) y c) la probabilidad de supervivencia mediante el método de Kaplan-Meier. Se toman como especificaciones de calidad los datos bibliográficos que reflejan la prestación actual de los programas de NPD existentes y los valores de supervivencia de los pacientes en diálisis por fracaso renal crónico. La patología más frecuente en nuestro medio es la benigna (70,8 por ciento) distribuyéndose como sigue: síndrome de intestino corto de origen isquémico (45,8 por ciento), síndrome de intestino corto de causa no isquémica (12,5 por ciento) y seudoobstrucción intestinal idiopática (12,5 por ciento). Los pacientes con patología benigna presentan una supervivencia más alta que los pacientes con enfermedad neoplásica (95 por ciento al quinto año de tratamiento frente a 45 por ciento a los 20 meses), siendo la diferencia estadísticamente significativa. El índice anual de complicaciones infecciosas es 0,6 (valor mediano de los 14 años estudiados). De igual modo los índices anuales de obstrucciones y trombosis son 0,11 y 0,0095, respectivamente. En nuestra opinión la calidad del programa de NPD existente en nuestro hospital es muy satisfactoria porque tanto la proporción de supervivencia como los índices anuales de complicaciones infecciosas y mecánicas son aceptables respecto a la prestación de los programas existentes a nivel internacional. Además, en términos de supervivencia la NPD resulta ligeramente más efectiva que la diálisis por fracaso renal crónico (AU)

The quality of home parenteral nutrition (NPD in its Spanish acronym) depends on the frequency and type of complication associated with NPD treatment and the likelihood of survival. The present study assesses the quality of the NPD programme in place in our hospital in terms of survival, infections and mechanical complications. A retrospective study was carried out into the clinical follow-up data of all the patients (n = 24) included in our NPD programme since its start in 1985 until 1998 (14 years). An estimate is made for: a) the annual index of infectious complications (IAC in its Spanish acronym), b) the annual index of mechanical complications (MAC in its Spanish acronym) and c) the likelihood of survival by means of the Kaplan-Meier method. The quality specifications adopted are those of the literature reflecting the current provision of NPD programmes and the survival values of patients undergoing dialysis for chronic kidney failure. The most frequent pathology in our context is benign (70.8%), distributed as follows: small bowel syndrome of ischaemic origin (45.8% ), small bowel syndrome of non-ischaemic origin (12.5%) and idiopathic intestinal pseudo-obstruction (12.5%). The patients with benign pathologies present a higher survival rate than patients with neoplasic disease (95% in the fifth year of treatment versus 45% at twenty months), with a statistically significant difference. The annual index of infectious complications is 0.6 (median value of the 14 years studied). Similarly, the annual indices of obstructions and thromboses are 0.11 and 0.0095, respectively. In our opinion, the quality of the NPD programme in place at our hospital is highly satisfactory because both the survival rate and the annual indices of mechanical and infectious complications are acceptable with regard to the programmes in place in the international sphere. In addition, in terms of survival, NPD seems slightly more effective than dialysis for chronic kidney disease (AU)

[Incidence and risk factors of mechanical complications in parenteral nutrition]. / Incidencia y factores de riesgo en las complicaciones mecánicas en nutrición parenteral.

The objective of the present study is to determine the incidence of mechanical complications in patients with parenteral nutrition in our hospital, and to study which factors associated with catheterization in these patients are related to the appearance of different types of mechanical complications. All the central venous catheters registered during the time period between 1988-1994 were included. For the statistical treatment 5 logistic multiple regression models were designed in function of the different types of mechanical complications studied (dependent variable) and in relation to the defined risk factors (independent variables). The difference was considered to be statistically significant when, for each variable, this is not 1 for the confidence interval. The understanding of the different risk factors associated with the appearance of mechanical complications allows a better level of clinical action in the prevention of these types of complications.

[The epidemiology of central venous catheterization (CVC) in parenteral nutrition. The clinical implications and factors that determine the selection of germs]. / Epidemiología de la cateterización venosa central (CVC) en nutrición parenteral. Implicaciones clínicas y factores que determinan la selección de gérmenes.

The objective of the study is, on one hand, to determine the etiology and the clinical implications as a function of the isolated germ, of central venous catheterization in patients with parenteral nutrition in our hospital, and on the other hand, to determine which factors are associated with the selection of germs of central venous catheterization in parenteral nutrition. For this we included venous catheters, colonized for 5 years, and with a study of the different segments (connection, insertion point, and tip). As a function of the appearance of associated clinical symptoms, of the results of the blood culture, and of the clinical evolution of the patient, the variables which determine the level of pathogenicity of the different groups of germs in the central venous catheterization, are defined; for the study of the factors associated with the selection of the different groups of germs, 8 variables were chosen. The data obtained are statistically treated, and the results are considered to be significant if p < 0.05. The understanding of the different factors associated with the selection of germs, and the level of clinical pathogenesis of the different groups, allows a better level of the clinical action in the prevention of the infection associated with the catheter.

[A practical nursing guide for the planning and evaluation of the care of the patient with domiciliary parenteral nutrition. The planning of patient care with DPN]. / Guía práctica de enfermería para la planificación y evaluación de los cuidados del paciente con nutrición parenteral domiciliaria. Planificación de cuidados del paciente con NPD.

We present a proposal for the planning of nursing care for the patient with home parenteral nutrition (HPN). In this proposal the problems, goals, and actions to be taken by the nurse are defined. In this working guide, it is explained what the diverse aspects are that the nurse taking care of a patient with HPN needs to know, as well as the care to be given and the evaluation of the same, in order to insure that the patient with HPN is given a good preparation in his self-care, giving the patient an acceptable degree of independence and quality of life, as well as a lower risk of complications.

[Description of the computer program used at the Hospital de Bellvitge for monitoring and control in the Parenteral Nutrition Unit]. / Descripción del programa informático utilizado en el Hospital de Bellvitge para el seguimiento y control de la Unidad de Nutrición Parenteral.

The purpose of this paper is to introduce a computer program to control the Pharmacy Service Parenteral Nutrition Unit. The program's main feature is a broad menu of possibilities for the clinical monitoring of patients receiving PN. We explain its operation, potential and applications and give some practical examples of some of those applications.

[The selection of the indicators for a quality control policy in parenteral nutrition starting from clinical follow-up]. / Selección de indicadores para una política de control de calidad en nutrición parenteral a partir del seguimento clínico.

INTRODUCTION: the concept of quality is basic to any type of clinical/care activity and with parenteral nutrition (NP), the notion is of particular significance in the field of its clinical monitoring. The aim of this paper is to reveal the NP care level based on our experience in clinical monitoring in 1988, and to select the indicators to be evaluated for initiating NP quality control. MATERIAL AND METHODS: An analysis is made of the existing structure in our hospital, formed by the NP Unit and the NP and Enteral Nutrition Commission, which are subject to a policy of coordination in order to ensure their function. The process is divided into two aspects for the analysis - teaching and care. The clinical monitoring data of NP patients in 1988 were taken as reference in defining the indicators. RESULTS: The indices are presented which were obtained from the analysis of the data of a general nature, from an assessment of the degree of compliance with the procedure, and from the quantification of complications and the indicators elected as quality parameters. DISCUSSION: Although the clinical monitoring of the PN began with the general wish to evaluate different aspects associated with nutritional therapy, this focus later evolved toward the notion of quality. Not all the data gathered during the clinical monitoring can be taken as quality criteria: only those deemed to be more relevant, or of greater clinical significance, and which can be reliably measured, can be treated thus.

[Qualitative follow-up of parenteral nutrition. Results]. / Seguimiento cualitativo de la nutrición parenteral. Resultados.

The Bellvitge Hospital has a Parenteral Nutrition Unit which is centralized in the Pharmacy Department. Its mission is to prepare the nutritive mixtures for all patients who require them. Based on the diffusion of the nursing protocol (reviewed in 1986), one of the main objectives of this Unit is to define the problems arising during the administration of parenteral nutrition, and offer alternatives. Similarly, it is also necessary to offer regular information on the results of the follow-up, which can be used as a reference on a daily basis, and when compared with the quality level established, will permit us to determine where we are at all times, thus preventing us from falling into routines that will harm the service we offer.

[Parenteral nutrition protocol: information for nursing care]. / Protocolo de nutrición parenteral: información a la enfermería asistencial.

For a correct application of PN (parenteral nutrition) protocols, not only is it essential to centralize follow-up, but also to make this known among the nursing staff. With this purpose in mind, the PN Unit organized in-depth seminars on the different hospitalization areas, after previously preparing a questionnaire indicating the extent to which the protocol was known among the staff. A study of the results obtained with the questionnaire enabled us to evaluate the following: the technical difficulties involved in basic understanding of the PN field, an analysis of priorities and the establishing of reference points for later evaluations.