Jpen Parenter Enter
-
Jpen Parenter Enter · Jan 1990
Serum iron, zinc, copper, selenium, and bromide concentrations after coronary bypass operation.
The effect of surgical trauma on serum trace elements was studied in 10 patients undergoing coronary bypass surgery. After the initial decrease due to the hemodilution during operation serum iron, zinc, copper and selenium remained depressed for the immediate postoperative period. Zinc was still at significantly lower level 2 months after the operation. ⋯ The multielemental technique also measured nonessential bromide, which returned to initial levels in 7 days. Effects of trauma on metabolism, acute phase reaction with redistribution of zinc and copper and losses via increased urinary excretion explain the above changes. Development of a subclinical deficiency of zinc and possibly iron is suggested by the persistence of low serum levels during recovery after operation.
-
Jpen Parenter Enter · Nov 1989
Effect of the continuous administration of fat emulsion on the infiltration of intravenous lines in infants receiving peripheral parenteral nutrition solutions.
Animal data and anecdotal human experience suggest that vascular damage induced by the infusion of dextrose/amino acid solutions may be ameliorated by the concomitant administration of fat emulsion. We prospectively evaluated the effect of the continuous infusion of peripheral nutrition solutions with and without fat emulsion on the incidence of, probability of, and time to infiltration of peripheral venous lines in infants (median age: 1.0 month; range 1 day-11.9 months). Ninety-seven peripheral venous lines were studied in 53 infants who received 10% dextrose (n = 34), 10% dextrose/2% amino acids (n = 30), or 10% dextrose/2% amino acids/fat emulsion (n = 33). ⋯ No site complications were associated with the infiltration of any solution. We conclude that the incidence of infiltration among the three solution groups studied is not different. However, the time to infiltration is prolonged and the probability of infiltration is decreased following the infusion of either dextrose alone or dextrose/amino acid/fat emulsion solutions when compared to the administration of dextrose/amino acid solutions without concomitant fat emulsion infusion.
-
Jpen Parenter Enter · Sep 1989
Identifying ICU patients who would not benefit from total parenteral nutrition.
This study attempted to improve patient selection for total parenteral nutrition (TPN) by identifying ICU patients whose prognoses were so hopeless that they would not or would no longer benefit from TPN. Computerized trend analysis of daily Apache II scores, corrected for the presence, number, and duration of major organ system failures was used to predict individual hospital outcome among 50 intensive care unit patients treated with TPN. ⋯ If TPN was withheld in the five patients predicted to die before starting TPN, or withdrawn in the eight patients when they were predicted to die, $28,350 or 11.5% of the cost of TPN during the study period would have been saved. This hypothetical study shows that elimination of inappropriate treatment of patients with hopeless prognosis with the aim of avoiding the prolongation of the process of dying and unnecessary suffering is a compassionate patient-selection strategy that can result in major savings in healthcare resources.
-
Jpen Parenter Enter · Jul 1989
Case ReportsNutrition during ten-week life support with successful fetal outcome in a case with fatal maternal brain damage.
A 31-year-old woman had fatal intracerebral bleeding at the beginning of the 21st week of gestation. After several days, there was evidence that the brain was dead. ⋯ A full-term normal 1600-g male was delivered and the later development of the child was normal. This case report demonstrates the possibility of providing nutritional requirements to the fetus even if the mother has had a fatal injury.
-
Jpen Parenter Enter · May 1989
A modified method of vascular access system implantation using the subclavian vein.
A new method of implanting vascular access systems using the Arrow Percutaneous Sheath Introducer Kit is described. The surgeon who frequently inserts these systems may find this technique to be a useful alternative in those patients in whom cutdowns were unsuccessful or in whom the percutaneous technique with a peel-away sheath is found to be difficult.