Jpen Parenter Enter
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Jpen Parenter Enter · Mar 1994
Comparative StudyHydrolysis of mixed lipid emulsions containing medium-chain and long-chain triacylglycerol with lipoprotein lipase in plasma-like medium.
We explored the effects of plasma-like conditions on hydrolysis of medium-chain triglyceride (MCT) and long-chain triglyceride (LCT) emulsions at different mixing ratios and the effect of the physical method of mixing on lipoprotein lipase hydrolysis of mixed emulsions in vitro. Mixed emulsions with two different mixing ratios, 50% MCTs with 50% LCTs and 70% MCTs with 30% LCTs by weight, were studied. Emulsions containing both MCT and LCT oils blended in the same emulsion particle were compared with mixtures of separate pure MCT emulsion particles and pure LCT particles. ⋯ In plasma-free systems, there were no differences in rates of hydrolysis of LCTs or MCTs (as individual triglycerides) between the two different mixing ratios of 50:50 and 70:30. However, the presence of plasma markedly diminished the differences in hydrolysis between blended vs separately mixed emulsions at pH 7.4. Also, in plasma-like incubation buffer, the rates of hydrolysis of MCTs and LCTs in emulsions with 50:50 or 70:30 MCT to LCT ratios reflected the respective amounts of MCT and LCTs in the emulsions.(ABSTRACT TRUNCATED AT 250 WORDS)
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Jpen Parenter Enter · Jan 1994
Comparative StudyThe effect of catheter type and site on infection rates in total parenteral nutrition patients.
Infections pose a major problem in patients receiving total parenteral nutrition. Controversy continues concerning the effect of catheter type (triple-, double-, single-lumen, or pulmonary artery), insertion site (subclavian, internal jugular, or femoral vein), and the incidence of catheter-related infections. We retrospectively studied multi-lumen catheter use for total parenteral nutrition over a 6-month period in 192 patients, a total of 3334 catheter days. ⋯ There were no differences in infection rates at any site based on catheter type; however, when triple-lumen catheter sites were compared, the differences were significant (p < .001 vs subclavian, chi 2). Catheter duration was 7.8 days (subclavian),, 7.3 days (internal jugular), and 4.6 (femoral) days. These data suggest that the use of multi-lumen catheters for total parenteral nutrition is safe, that there is a benefit associated with the subclavian route, and that the femoral site should be avoided.
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Jpen Parenter Enter · Nov 1993
Odd-numbered medium-chain triglycerides (trinonanoin) in total parenteral nutrition: effects on parameters of fat metabolism in rabbits.
Odd-numbered medium-chain triglycerides (MCTs) might combine the advantages of "usual" MCTs applied in clinical nutrition with lower ketogenic action and the release of three carbon units. To test subacute toxicity, trinonanoin/long-chain triglyceride (LCT) (7/3 wt/wt) fat emulsions were given to rabbits (n = 8) for 11 days (7 h/d) within a total parenteral nutrition regimen at a dose of 46.5% of total daily energy. Comparisons were made with rabbits receiving equicaloric amounts of MCT/LCT (7/3, wt/wt) or pure LCT fat emulsions, as well as with orally fed controls. ⋯ The histologic examination of the gut mucosa revealed no distinct differences between groups. On the basis of the presented data, the trinonanoin/LCT emulsion showed no inferiority to "usual" MCT/LCT emulsions. The lower ketogenic effect as well as the marked increase in plasma short-chain fatty acid concentrations may encourage further testing of this substrate for total parenteral nutrition.
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Radiographic confirmation of enteral feeding tube placement is a common practice representing considerable expense and causing delay in the initiation of enteral nutrition therapy. We evaluated an enteral feeding tube with a pH sensor, which allows immediate verification of the location of the tube by assessment of the pH upon insertion. ⋯ The radiograph and the insertion pH profile were in agreement in 87.5% (21 of 24) of the cases. Concomitant use of histamine blockers did not affect the ability of the pH sensor to detect placement accurately (Fisher's Exact Test, p 5.71) Use of these pH measurements eliminates the need for radiographic documentation of placement, provides a savings for the patient, and may be beneficial in promoting enteral feedings in critically ill patients.
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Jpen Parenter Enter · Nov 1993
Case ReportsPulmonary embolism as a complication of long-term total parenteral nutrition.
Although much has been written concerning the complications of long-term total parenteral nutrition, little or no mention of pulmonary embolism is made in the literature. We present two patients maintained on home total parenteral nutrition who suffered pulmonary emboli, one while receiving standard heparin therapy. No potential source other than their indwelling total parenteral nutrition catheter was identified. ⋯ Future development of less thrombogenic catheters will also be of assistance. Thrombolytic agents currently have an expanding role in the treatment of thrombotic complications. Whether they will have a future role in prevention remains unknown.