Jpen Parenter Enter
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Jpen Parenter Enter · Jan 2001
Case ReportsPercutaneous placement of an intercostal central venous catheter for chronic hyperalimentation guided by transhepatic venography.
Increased utilization of central venous catheters for hyperalimentation has caused a rise in the incidence of central venous complications including occlusions and stenoses. When this occurs, the continued use of these catheters becomes more difficult. We describe a technique for catheter placement in a patient requiring access for total parenteral nutrition who had extensive central venous occlusion involving both internal jugular veins, both subclavian veins, and the infrorenal inferior vena cava (IVC). ⋯ Patients who require long-term central venous access often develop stenotic and occlusive complications in the central venous circulation. Individualized, unique and innovative routes to the central venous circulation must often be utilized to maintain venous access in these patients. Transhepatic venous mapping and microcatheter techniques aid in the finding of alternative sites in these patients with difficult access problems.
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Jpen Parenter Enter · Jan 2001
Randomized Controlled Trial Clinical TrialVerbal and visual memory improve after choline supplementation in long-term total parenteral nutrition: a pilot study.
Previous investigations have demonstrated that choline deficiency, manifested in low plasma-free choline concentration and hepatic injury, may develop in patients who require long-term total parenteral nutrition (TPN). Preliminary studies have suggested lecithin or choline supplementation might lead to improved visual memory in the elderly and reverse abnormal neuropsychological development in children. We sought to determine if choline-supplemented TPN would lead to improvement in neuropsychological test scores in a group of adult, choline-deficient outpatients receiving TPN. ⋯ This pilot study indicates both verbal and visual memory may be impaired in patients who require long-term TPN and both may be improved with choline supplementation.