Fistula Isolation and the Use of Negative Pressure to Promote Wound Healing: A Case Study.

BACKGROUND: A 54-year-old morbidly obese woman with a small bowel obstruction and large ventral hernia was admitted to hospital. She underwent an exploratory laparotomy, lysis of adhesions, and ventral hernia repair with mesh placement. She subsequently developed an enteroatmospheric fistula; several months of hospital care was required to effectively manage the wound and contain effluent from the fistula. METHODS: Several approaches were used to manage output from the fistula during her hospital course. She was initially discharged to a skilled nursing facility where a fistula management pouch was used for several months to encompass the wound and contain effluent, but this method ultimately proved ineffective. The fistula was then isolated using a collapsible enteroatmospheric fistula isolation device and an ostomy appliance to contain effluent. CONCLUSION: The application of the collapsible enteroatmospheric fistula isolation and effluent containment devices in conjunction with negative-pressure wound therapy produced positive patient outcomes; it improved patient satisfaction with fistula management, promoted wound healing, and diminished cost.

[Treating the somatic complications of anorexia]. / Traiter les complications somatiques de l'anorexie.

Anorexia can cause serious somatic complications, linked to undernutrition or associated pathological behaviours. The care pathway drawn up by a multi-discipline team is a real therapeutic challenge. Oral nutritional supplements, enteral nutrition and parenteral nutrition are three possible forms of nutritional assistance.

Central venous catheter-induced pericardial effusion in a neonate: a case study and recommendations for practice.

Pericardial effusion (PCE) and tamponade as a complication of central venous catheters (CVCs) continues to occur in the neonatal population. It is imperative that clinicians managing neonates with CVCs practice vigilance regarding proper catheter tip location. Furthermore, it is of equal importance that clinicians have a high index of suspicion regarding the catheter tip location any time a neonate with a CVC has a clinical deterioration. It is clear that the ultimate outcome of PCE depends on rapid identifi cation and a quick response when pericardial tamponade occurs. PCE can occur any time during the duration of the catheter dwell time, and education of staff caring for neonates will assist in prevention and rapid treatment.

The effect of in-line infusion filtering on in-line pressure monitoring in an experimental infusion system for newborns.

AIM: To study the effect of in-line filtering on in-line pressure measurement in a simulated infusion system. METHODS: The experimental setup consisted of a syringe pump, syringe, intravenous (IV) line, and extension line. For aqueous fluids, a 0.2-µm infusion filter was used, and for lipid emulsions, a 1.2-µm filter. Infusion speed varied from 0.5 to 10.0 mL/h. First, the effect of clamping the extension line was studied on reaching alarm threshold. Second, the effect of aqueous and lipid fluids was evaluated on in-line pressure measurements. RESULTS: In-line placement of an infusion filter did not prolong the time to alarm threshold after occlusion. During 24 hours of monitoring, lipid emulsions and all-in-one admixture only caused a moderate increase in in-line pressure. CONCLUSION: Placement of an infusion filter does not have a significant effect on the in-line pressure monitoring and has no adverse effect on detecting pressure-related complications of IV administration.

Review of micronutrients in parenteral nutrition for the NICU population.

A recent review of macronutrients in parenteral nutrition (PN) in the NICU population summarized the carbohydrate, protein, and fat nutrients in PN.1 The purpose of this article is to review the other nutrients in PN that are important for growth and homeostasis including minerals or electrolytes, vitamins, and trace elements. Although the macronutrients contribute more dramatically to adequate nutrition and growth, the other components in PN have significant impact on use of macronutrients as well as targeted organ and cellular function.

Extending total parenteral nutrition hang time in the neonatal intensive care unit: is it safe and cost effective?

AIM: To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload. METHODS: A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload. RESULTS: One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442 g (±101) versus 2476 g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group; P < 0.05). Annual cost saving using 48-h TPN was AUD 97,603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced. CONCLUSION: Extending TPN hang time from 24 to 48 h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects.

Educational outcomes associated with providing a comprehensive guidelines program about nursing care of preterm neonates receiving total parenteral nutrition.

Poor understanding or practice of Total Parenteral Nutrition (TPN) causes devastating complications. Therefore, good Neonatal Intensive Care Unit (NICU) nursing care for preterm neonates and close monitoring of complications is essential for successful TPN therapy. The study was conducted in NICU at Ain Shams University Hospital in Cairo, Egypt, using a quasi-experimental research design with prepost intervention assessments. Data was collected using a self-administered questionnaire sheet and an observation checklist (prepost format) and developed a comprehensive guidelines program about nursing care of TPN of preterm neonates. Results revealed that the program had a significant positive impact on nurses' knowledge and practice outcomes.

Conocimientos y prácticas de la enfermera sobre medidas de bioseguridad durante la administración de la NPT y la NET en pacientes hospitalizados en el Servicio de UCI 2C HNERM - EsSalud Lima - Perú / Knowledge and practices of the nurse about biosecurity measures for the administration of the NPT and the NET in hospitalized patients in the Service ICU 2C - HNERM - EsSalud Lima - Peru

El estudio "Conocimientos y prácticas de la enfermera sobre medidas de bioseguridad en la administración de NPT y NET en pacientes hospitalizados en la UCI 2C HNERM-ESSALUD 2009" tuvo como objetivo determinar los conocimientos y prácticas que tiene la enfermera sobre las medidas de bioseguridad durante la administración de la NPT y la NET. Material y Método: El estudio de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población estuvo conformada por 29 enfermeras que laboran en el servicio de UCI 2C de HNERM. La técnica fue la observación y la encuesta; los instrumentos una lista de Chequeo y un Cuestionario, los cuales fueron aplicados previo consentimiento informado. Resultados: Del 100 por ciento (29) enfermeras, 59 por ciento (17) conocen y 41 por ciento (12) no conocen sobre las medidas de bioseguridad durante la administración de la NPT-NET; respecto a las prácticas de medidas de bioseguridad en la administración de la NPT-NET 52 por ciento (15) tienen practicas inadecuadas y 48 por ciento (14) practicas adecuadas. Conclusiones: El mayor porcentaje de los enfermeras conocen sobre medidas de bioseguridad durante la administración de la NPT y la NET, para que este soporte nutricional sea preciso y seguro, seguido de un porcentaje significativo que no conoce sobre las principales barreras de protección que se aplican durante la administración de la NPT-NET, las complicaciones más frecuentes con la NET, en cuanto a las prácticas de medidas de bioseguridad durante la administración de la NPT-NET, un gran porcentaje de enfermeras tienen prácticas inadecuadas; ya que no evalúan la saturación oxígeno del paciente en cada turno, no se colocan mandilón, guantes estériles, mascarilla y gorra al inicio la NPT-NET, ni calibran la bomba infusora en cada turno, siendo un riesgo todo el procedimiento, predisponiendo de esta manera al paciente critico a adquirir infecciones intrahospitalarias y retardar su proceso de recuperación.

The study, "Knowledge and practices of the nurse on biosecurity measures in the TPN and TEN in patients hospitalized in the ICU 2C HNERM-ESSALUD 2009" aimed to determine the knowledge and practices that have the nurse about biosecurity measures during administration of the NPT and the NET. Methods: The study-Ievel application, quantitative, cross-sectional descriptive method. The sample consisted of 29 nurses working in the ICU service HNERM 2C. The technique was the observation and the survey instruments a checklist and a questionnaire, which were applied prior informed consent. Results: 100 per cent (29) nurses, 59 per cent (17) know and 41 per cent (12) do not know about biosecurity measures during administration of TPN-NET; regarding biosecurity practices in the administration of TPN-NET 52 per cent (15) have inadequate practices and 48 per cent (14) practices. Conclusions: The highest percentage of nurses know about biosecurity measures for the administration of the NPT and the NET, this nutritional support for accurate and safe, followed by a significant percentage who do not know about the main barriers of protection that apply during the TPN administration-NET the most common complications with the NET, in terms of biosecurity practices during the administration of the NPT-NET, a large percentage of nurses have inadequate practices, and do not assess the patient's oxygen saturation every turn, not placed gown, sterile gloves, mask and cap to top the NPT-NET infuser pump calibrated every shift, being a risk throughout the procedure, thus predisposing the patient to acquire critical nosocomial infections and slow your recovery process.

A previously undescribed etiology for oliguria in a premature infant with a peripherally inserted central catheter.

Peripherally inserted central catheter use has become widespread in the management of premature infants as a means to provide long-term intravenous therapy and nutritional support until enteral feedings can be established. Peripherally inserted central catheters are not without complications. This article describes the case of a premature infant with oliguria with the suspected etiology of a malpositioned catheter tip at a location where it was either occluding/blocking the renal vein(s) or causing damage to the kidney(s) from administration of hypertonic total parenteral nutrition solution directly into the renal vein(s). Peripherally inserted central catheter position should be verified radiographically and evaluated serially in any infant, even more so in an infant with symptoms of oliguria and possible sepsis.

Adult total parenteral nutrition at Auckland City Hospital: a 6-year review.

AIM: To summarise and evaluate data on the use of total parenteral nutrition (TPN) and associated septic complications at Auckland City Hospital (Auckland, New Zealand) over a 6-year period beginning with appointment of a specialist TPN nurse. METHODS: For each adult patient requiring TPN on an inpatient basis (excluding those in critical care) between January 1998 and December 2003 demographic data, reason for TPN requirement, number of days of TPN administration, type of central venous line used for administration, and frequency of infectious complications were collected prospectively. RESULTS: 498 episodes of TPN were recorded in 484 patients (202 male, median age 60, range 15-89 y). Median duration of TPN administration was 11 (range 1-326) d. Over the 6-year period the number of episodes of TPN per year did not change significantly while median duration of TPN decreased from 14.5 d in 1998 to 8 d in 2003 (p<0.0001). Paralytic ileus following abdominal surgery was the predominant indication for TPN. After 1998, the rate of catheter-related bloodstream infections stabilised at 2 per 1000 TPN days. CONCLUSIONS: These results provide a benchmark for infection rates associated with administration of TPN managed by a Nutrition Support Team in a New Zealand tertiary care hospital.

Catéteres venosos centrales en nutrición parenteral total (NPT) - Rol de la enfermera especializada / Central Venous Catheters in Total Parenteral Nutrition (TPN) - Role of the Specialized Nurse

En el Hospital Nacional Edgardo Rebagliati Martins, en la Unidad de Soporte Nutricional Artificial (USNA), son dos las formas más utilizadas para la colocación de catéteres venosos centrales: los cirujanos especialistas, aplicando la técnica de Seldinger, colocan los catéteres venosos centrales tunelizados CVCT, de un sólo lumen, y los catéteres centrales de inserción periférica PICC, de un sólo lumen también. El abordaje de las venas basílica o cefálica derecha o izquierda de los miembros superiores se hace mediante la técnica percutánea; estos catéteres son colocados por la enfermera de la Unidad de Soporte Nutricional. El cuidado que brinda la enfermera especializada se basa en cuidados protocolizados, establecidos por la evidencia de una baja tasa de infecciones relacionadas con catéteres centrales utilizados exclusivamente en la administración de nutrición parenteral total.

There are two methods most often used for the placement of central venous catheters in the Artificial Nutritional Support Unit of the National Hospital Edgardo Rebagliati Martins. Specialized surgeons, who apply the Seldinger technique, place the single lumen tunneled central venous catheters TCVC, and the single lumen peripherally inserted central catheters PICC. The approach to the cephalic and basilic veins of the upper limbs is done with the use of percutaneous technique; these catheters are placed by nurses that work at the Nutritional Support Unit. The care provided by the specialized nurse is based on protocolized cares, established by the evidence of low infections rate related to central catheters used exclusively in total parenteral nutrition.

Supporting nutrition with T.E.N. or T.P.N.

Learn the pros and cons of each type of specialized nutrition support and how to prevent problems related to therapy.