Jpen Parenter Enter
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Jpen Parenter Enter · Sep 1993
Randomized Controlled Trial Comparative Study Clinical TrialTotal parenteral nutrition with glutamine in bone marrow transplantation and other clinical applications (a randomized, double-blind study)
In a paper by Ziegler et al (Ann Intern Med 116: 821-828, 1992), total parenteral nutrition supplemented with L-glutamine (TPN/GLN) was reported beneficial in patients receiving bone marrow transplantation (BMT) for hematologic malignancies. By using a similar protocol, we studied 29 patients with both hematologic malignancies and solid tumors, and with both allogeneic and autologous BMTs. In a double-blind, randomized approach, patients were given isocaloric, isonitrogenous TPN after BMT until they consumed 50% of their required diet orally. ⋯ When the groups were subdivided into patients with hematologic malignancies and those with solid tumors, there were no significant differences in the above variables associated with TPN/GLN. In 17 of 30 additional hospitalized patients receiving standard TPN, substitution of TPN/GLN did not have discernible clinical or laboratory effects but appeared to be safe. Inclusion of patients with solid tumors and a higher mortality in our patients may have obscured beneficial effects of TPN/GLN observed by others.
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Jpen Parenter Enter · May 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of weighted vs unweighted enteral feeding tubes for efficacy of transpyloric intubation.
Routine transpyloric placement of feeding tubes reduces aspiration in intensive care unit patients. Spontaneous passage eliminates the need for radiologic or endoscopic intervention. It is unclear whether the addition of a weight to the end of the tube or the use of the prokinetic agent metoclopramide in the conventional dose (10 mg) improves spontaneous transpyloric placement. ⋯ The occurrence of transpyloric passage and the rapidity at which it occurred was significantly greater for the unweighted tube during all time periods. A poststudy trial was conducted to evaluate the effect of the normal dose of metoclopramide (10 mg in adults and 0.1 mg/kg in children) and the transpyloric passage of the unweighted feeding tube. Twenty-five patients received 10 mg of metoclopramide before the insertion of the unweighted tube.(ABSTRACT TRUNCATED AT 250 WORDS)
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Jpen Parenter Enter · May 1993
Case ReportsSpontaneous separation and migration of a metal splice segment of a repaired Hickman catheter.
Repairs to the external silicone central venous catheter segment are done to correct mechanical defects caused by natural wear and tear or traumatic catheter injury. The ability to repair a damaged catheter obviates the need for surgical replacement. ⋯ We report a case in which the metal piece separated from the replacement segment of a Hickman catheter. This metal piece lodged 1 cm from the catheter entrance to the anterior chest and caused incomplete catheter occlusion.
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Jpen Parenter Enter · Mar 1993
Volume of blood required to obtain central venous catheter blood cultures in infants and children.
To determine how much blood must be discarded before one can obtain a reliable central venous catheter blood culture, we prospectively cultured the blood (from 96 patients) that is ordinarily discarded before obtaining blood for such a culture. We then compared the prospective culture results with those of the actual blood culture. ⋯ The culture results of the second aliquot were comparable to those of the third (the portion usually cultured) in overall sensitivity (94.4%), specificity (94.9%), and positive predictive value (80.9%). Thus, the amount of blood that must be discarded (infants: 0.3 mL; children: 1.0 mL) before one can obtain an accurate central venous catheter culture is less than was previously thought.