Abstract
BackgroundThe Leicestershire intestinal failure team (LIFT) service provides specialist intestinal failure care to patients in Leicestershire and surrounding counties.AimsTo study the epidemiology of intestinal failure (IF) cases referred to the service and review outcomes particularly the indications and delivery of parenteral nutrition (PN). To review catheter-related sepsis (CRS) rates and identify areas for improvement.MethodsService data from January 2016 to November 2017 was analysed retrospectively. Descriptive and inferential statistical analysis was carried out. Chi-square/Fisher Exact tests were used to identify significance on categorical data and non-parametric settling was used for qualitative data analysis.ResultsA total of 365 patients were referred to the service from January 2016 to November 2017. 58% patients had grade I intestinal failure. 34% and 24% referrals were made by the colorectal and hepato-pancreato-biliary (HPB) units, respectively. Gut rest (27%) and small bowel obstruction (25%) were the most common indications for nutritional support. Duration of PN requirements varied greatly, but most patients (39%) required it for up to seven days. Single lumen PICC line (64%) and cephalic vein (54%) were the most commonly used catheter and site of vascular access, respectively. Chronicity of IF and number of vascular catheters required to provide PN were significantly associated with rates of CRS.ConclusionCRS was found to be statistically significantly associated with chronic IF and number of vascular access catheters required to provide PN. Cost implication and morbidity of CRS could be analysed further to identify other ways to provide safer and cost-efficient parental nutrition for patients with intestinal failure.
Highlights
Intestinal failure (IF) was first defined in 1981 by Fleming and Remington as “a reduction in the functioning gut mass below the minimal amount necessary for adequate digestion and absorption of food” [1]
A total of 365 patients were referred to the service from January 2016 to November 2017. 58% patients had grade I intestinal failure. 34% and 24% referrals were made by the colorectal and hepato-pancreato-biliary (HPB) units, respectively
Chronicity of intestinal failure (IF) and number of vascular catheters required to provide parenteral nutrition (PN) were significantly associated with rates of Catheter-related sepsis (CRS)
Summary
Intestinal failure (IF) was first defined in 1981 by Fleming and Remington as “a reduction in the functioning gut mass below the minimal amount necessary for adequate digestion and absorption of food” [1]. IF can occur relatively abruptly, or may be the slow, progressive evolution of a chronic illness. It may either be a self-limiting short-term or a long-lasting condition [3]. Treatment of chronic intestinal failure (CIF) is based on providing intestinal rehabilitation with a target to restore intestinal function through nutrition, pharmacological and/or surgical therapy [4]. Those patients with irreversible intestinal failure will require long-term or lifelong home parenteral nutrition (HPN) or will need intestinal transplantation [5]. The Leicestershire intestinal failure team (LIFT) service provides specialist intestinal failure care to patients in Leicestershire and surrounding counties
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