Since establishment of HPN training in Wales, there has been a rapid increase in numbers on long-term HPN, from 7.3/10 6 in 2002, to 20/10 6 currently. HPN training has been undertaken at the University Hospital of Wales (UHW) since 2000. We review here the outcomes and complications of home parenteral nutrition (HPN) in Cardiff since establishment of the service.Fifty patients have been managed at home on HPN since 2000. Of these 43 were trained at UHW (7 were trained in Manchester or St Marks prior to 2000). We present a review of outcomes of therapy, particularly mortality and duration of feeding. For patients currently on feeding, catheter-related complications (infection and thrombosis), level of bone disease and liver function are presented. Data were collected from the HPN database and electronic results reporting and clinical notes. Infection rates are presented for the year April 2008-March 2009 and presented as catheter-related infections (CRI) per 1000 feed days during this time. SPSS was used for statistical analysis.Crohn's and infarction were two major aetiological factors for intestinal failure accounting for 17 (34 %) and 9 (18 %), respectively. Fistulae 7 (14 %), radiation enteritis 2 (14 %) and enteropathy 8 (16%) (SLE, Scleroderma, Chronic Pancreatitis, Intestinal lymphangiectasia, MCTD) were some of the other causes. Of the 50 patients, 8 have died (only 1 death was HPN-related (haemorrhage as a consequence of anticoagulation following multiple large vein thromboses)). All other deaths were due to underlying disease. HPN was stopped after planned restorative surgery in 7 patients, and 2 were able to manage on subcutaneous fluids and magnesium without HPN. The remaining 33 are still on HPN. Nineteen (57.6%) female, with a median age of 57 years (range 17-77). No patients have been accepted onto a small intestinal transplant waiting list.Complications in patients currently on HPN (n = 33) Infection: Over the year 2008-9, 6 (20 %) had documented CRI. Four occurred in out-patients giving a rate of 0.43 CRI/1000 feed days, with three treated with antibiotics and catheter salvage and only one requiring line replacement. Two infections occurred prior to initial discharge from hospital. Two significant infective complications occurred (cervical discitis treated with long-term antibiotics and cervical osteomyelitis treated with surgery and antibiotics). The latter infection was likely related to previous intravenous pethidine use for chronic pain.Metabolic bone disease: In spite of widespread use of intravenous bisphosphonates, there is significant bone loss, correlating with duration of HPN (r = 0.403, P = 0.022). Five patients have severe symptomatic osteoporosis with kyphosis and/or fractures. In the total cohort, the average "T" score was -1.8 (SD 1.6) for lumbar spine and -2.0 (SD 1.2) for Hip. The lumbar spine was normal, osteopenic and osteoporotic in 7 (21%), 13 (39%), 8 (24 %) patients, respectively. For the Hip, it was normal, osteopenic and osteoporotic in 4 (12 %), 17 (51 %) and 7 (21 %) p...
The policy for insertion of a fine-bore nasogastric (NG) feeding tube was developed and implemented by the nutrition support team (NST) in 1999. This enabled the procedure to be undertaken by nurses, a role previously undertaken by doctors. It also introduced pH measurement of gastric aspirate as an alternative to x-ray to confirm correct position. In order to facilitate the change in practice the NST developed a formal teaching session. The interactive and practical 3-h session is delivered by the multidisciplinary NST and incorporates Trust guidelines for NG tube insertion, confirmation of position, feed and drug administration as well as troubleshooting. A questionnaire to assess baseline knowledge is completed by the staff at the beginning of each session. This consists of ten true/false statements (S1-10) relating to placement, confirmation of position and maintenance of the tube, all of which are discussed during the session. This review aimed to quantify the education undertaken by the NST and to assess its effect on the baseline knowledge of staff within the Trust. Registration and attendance forms in addition to baseline knowledge questionnaires and evaluation reports were reviewed for the sessions held over the 7-year period.During the 7-year period between June 2000 and May 2007, a total of thirty-five sessions were held, ranging from two to eight sessions per year. Records were missing or incomplete for three of these sessions. 631 staff reserved a place for thirty-three of the thirty five sessions, average nineteen (range eight to twenty-eight) per session. Of those who reserved a place, 63 % (range 8-87%) attended. An additional 104 attended without prior reservation, average three (range zero to eleven) per session. Overall a total of 504 staff attended sessions during the 7 years, average fifteen (range four to twenty-five) per session. A total of 96 % were nursing staff, 3 % dietitians and 1 % pharmacists. Of staff 84 % were from the acute hospital sites (two), 14 % from outlying hospitals within the Trust (six) and 2 % from primary care.A total of 443 baseline knowledge questionnaires were completed, average 88 % (range 61-100%) per session. There has been no overall improvement in baseline staff knowledge despite 7 years of education. Results suggest knowledge of:
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