Jpen Parenter Enter
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Jpen Parenter Enter · May 1999
Randomized Controlled Trial Clinical TrialOral and parenteral glutamine in bone marrow transplantation: a randomized, double-blind study.
Total parenteral nutrition (TPN) supplemented with glutamine (GLN) has been reported to be effective for patients with bone marrow transplantation (BMT). Our aim was to evaluate enteral and parenteral glutamine in patients undergoing BMT. ⋯ Oral and parenteral GLN seemed to be of limited benefit for patients having AUTO or ALLO BMT for hematologic or solid malignancies. Further study of long-term effects of GLN in BMT seems warranted.
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Jpen Parenter Enter · Mar 1999
Comparative StudyPeripherally inserted central catheters for parenteral nutrition: a comparison with centrally inserted catheters.
Central venous access is crucial for the provision of adequate parenteral nutrition (PN). The type of central venous access device (CVAD) has evolved over the past 10 years. The most recent trend has been to use peripherally inserted central catheters (PICCs). This development has occurred without controlled clinical trials. ⋯ PICCs have replaced tunneled and nontunneled central catheters as the most commonly used CVAD for providing PN. PICCs do not result in increased line sepsis or thrombosis but have an increased incidence of local complications such as leaking catheters, phlebitis, and malposition.
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Jpen Parenter Enter · Nov 1998
Multicenter Study Comparative StudyAre patients fed appropriately according to their caloric requirements?
Specific morbidity related to underfeeding and overfeeding necessitates the design of nutrition support regimens that provide calories equal to those required on the basis of energy expenditure. This prospective multicenter trial was designed to determine what percent of patients in long-term acute care facilities receive feeding appropriate to their needs and whether accuracy of feeding has an impact on patient clinical status. ⋯ Because energy expenditure is difficult to predict on the basis of conventional equations, patients in long-term acute care facilities routinely are overfed and underfed, with only 25% receiving calories within 10% of required needs. Measuring a patient's energy requirement at least once by IC is important, because the degree of metabolism predicts how easily a patient will be underfed or overfed. The amount of infused calories should be compared with caloric requirements measured by IC, because the accuracy or degree of underfeeding or overfeeding has an impact on ventilatory status and the likelihood for developing azotemia. Although physician practice or bias may reduce the optimal clinical effect, the use of IC to determine caloric requirements may result in significant cost savings.
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Jpen Parenter Enter · Sep 1998
Total nutrient admixtures appear safer than lipid emulsion alone as regards microbial contamination: growth properties of microbial pathogens at room temperature.
The extraordinary growth properties of most microorganisms in 10% and 20% lipid emulsions has led to the Centers for Disease Control and Prevention recommendation that if lipids are given through an i.v. line, the administration set should be replaced every 24 hours rather than the usual 72-hour interval used for crystalloid solutions, including those used for conventional total parenteral nutrition. For nearly 15 years, parenteral alimentation has been given as a total nutrient admixture (TNA), with the glucose, amino acids, and lipid mixed within the same bag and infused continuously over 24 hours. ⋯ We conclude that TNA is a poor growth medium for most nosocomial pathogens and is no better than D5%/W. The need to replace administration sets every 24 hours with TNA should be reconsidered and ideally be studied in a prospective randomized trial.
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Jpen Parenter Enter · Sep 1998
Effects of soybean oil and fish oil emulsions on glucose and lipid metabolism in streptozotocin-induced diabetic rats receiving total parenteral nutrition.
This study was designed to investigate the effects of fat emulsions with different fatty acid composition on plasma glucose and lipid metabolism in diabetic rats receiving total parenteral nutrition (TPN). ⋯ These results suggest that compared with soybean oil, TPN with fish oil emulsion did not lead to lower plasma concentrations of TGs and NEFAs in STZ-induced diabetic rats. Also, no difference in plasma glucose and insulin levels between the two groups was observed.