Impact of a nutritional support service on VA surgical patients.

Abstract

The impact of a multidisciplinary Nutritional Support Service (NSS) on the reduction of complication was evaluated in 78 consecutive patients who received total parenteral nutrition (TPN) on the same VA surgical service. Patients were placed into one of three groups (pre-NSS, transition-NSS, post-NSS) based on the evolution of the NSS. A significant reduction in catheter sepsis was observed and was attributable to the establishment of an NSS, specifically, a nurse specialist and protocols for catheter insertion and care.

Does a multidisciplinary total parenteral nutrition team improve patient outcomes? A systematic review

“…There were no randomized controlled trials identified, and all 11 studies were comparative in design, 4 with concurrent controls 2-4,12 and 7 with historical controls. 5,6,[13][14][15][16][17] The methodological quality of the studies were limited, as none of the studies provided a clear description of the inclusion and exclusion criteria, and only 2 studies 4,13 reported that the groups were treated identically other than for the named intervention. Table I presents a summary of the methodological quality of the included studies.…”

“…The sample sizes in the trials were generally small and ranged from 28 2 to 285, 17 subjects, with 5 studies having unequal sample sizes between the comparison groups. 3,5,6,15,17 The mean duration for the administration of TPN therapy ranged from 7.1 days 2 to 26 days 16 and was administered using either a central [3][4][5][6][12][13][14][15]17 or peripheral 4,5,12 venous catheter. In 2 studies, 2,4 patients received oral and or enteral nutrition during the transitional phase of TPN therapy.…”

“…3,4,14 -16 In 1 study, 3 infected catheters were classified as a mechanical complication. All studies reported a reduction in total mechanical complications in patients managed by the TPN team: 3.6%, 4 10%, 16 11.1%, 14 12.2%, 15 24%, 12 and 23%. 3 However, none of the studies reported a statistically significant difference.…”

“…Six studies reported mechanical complications: air embolism, 12,15,16 catheter malposition, 3,12,14 blocked catheter, 14 subclavian artery puncture, 12 dislodgment or disconnection of catheter, 12 infected catheter, 3 subclavian vein thromboses, 16 and pneumothorax. 3,4,14 -16 In 1 study, 3 infected catheters were classified as a mechanical complication.…”

Assessing the Nutrition Support Team

“…Numerous papers have associated the establishment of an NST with improved clinical outcome and/or reduction in costS.25, 28,30,34,66,[70][71][72][73][74][75][76][77][78][79][80][81][82][83] The apparent implication of such data is that every hospital should have an NST. A difficulty with interpreting and implementing such a conclusion is the wide variability in already established NSTs, as discussed above.…”