However, peripheral PN is not a long-term solution. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Self-care research: Where are we now? The nutritional content of the parenteral supply is limited by the type of vascular access available. In response to the high rate of infections associated with CVCs, the use of CVCs impregnated with antimicrobials such as chlorhexidine and silver sulfadiazine (silver coated) or with minocycline and rifampin have been investigated for risk of infection when compared with untreated CVCs. (2002) compared silver-coated to untreated catheters by randomizing 233 cancer patients undergoing chemotherapy, including 84 patients receiving autologous hematopoietic stem cell transplantation (HSCT). This considerably simplifies the act of catheter access and improves patient independence. These catheters are relatively small in diameter (2-Fr or 22-gauge).

Using Cox regression analysis, Port-a-caths had a hazard ratio of 3.0 compared with 2.8 for tunneled catheters. For long-term use, especially in patients going home on PN, PICC lines are best placed to the upper arm (brachial vein) under ultrasound and fluoroscopic guidance. (1998) conducted a retrospective review of 283 tunneled CVCs compared to 555 PICCs. A draft contract is an agreement that’s not finalized. Obtenir des informations en XML pour filtrer le meilleur contenu. The mission of the Center is to lead the self-care research endeavor, improving conceptual clarity and promoting interdisciplinary work informed by a shared vision addressing knowledge gaps. Lisa M. Kohr, Nancy J. Braudis, in Paediatric Cardiology (Third Edition), 2010, Parenteral nutrition and intralipids should be started when the initiation of enteral feedings is not an option for ensuring metabolic needs.28 Due to the high incidence of respiratory problems, limited gastric capacity, and intestinal hypomotility of premature infants, enteral feeds should be initiated and advanced in slow fashion.29 Parenteral nutrition supplements the calories provided by limited enteral feedings to ensure the nutritional needs. It is supplied by manufacturers in concentrations ranging from 2.5% to 70%.

Peripheral access is obtained by standard venipuncture into a peripheral vein. The femoral vein should be used only when placement in the jugular or subclavian vein is contraindicated or not possible. Fluid needs are not only influenced by age and weight, but also by insensible losses, as well as the underlying medical condition or disease state. Sometimes, multilumen catheters are used, but studies have shown higher infection rates in multilumen catheters versus single lumen catheters. Placement in the internal jugular vein, compared with the subclavian vein, appears to be associated with a slightly higher risk of infection and a clearly higher risk of thrombosis. The catheter used to deliver PN should be a dedicated line used for nothing else in order to minimize the risk of infection. Lipid tolerance of 20% solutions is superior to that of 10% solutions due to their lower content of phospholipid emulsifiers.28 For term infants born with low weight, parenteral nutrition should be instituted within the initial 3 days of life if enteral feeds are contra-indicated due to concerns of necrotizing enterocolitis or extracardiac anomalies such as tracheoesophageal fistula, duodenal atresia, and gastroschisis.29 In such infants born with low weight, it has been shown that the average retention of nitrogen improved even when the intake of energy was less than 30 kcal/kg per day when protein, 1.15 g/kg per day, was initiated on the first day of life.28, The rate of glomerular filtration, and the distal and proximal tubular function, are decreased in infants of less than 34 weeks of gestation. (1999) were able to demonstrate safe use of Port-a-caths in 120 chemotherapy patients with solid tissue malignancies. Subcutaneous ports are less obtrusive and therefore cause less disturbance to body image.


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