Patients Receiving Home Parenteral Nutrition Research Articles

Osteomyelitis of the Clavicle Secondary to Infected Hickman Catheter

A patient receiving home parenteral nutrition developed osteomyelitis of the clavicle associated with a Hickman catheter which had been functioning for 14 months. The infection was treated with bone curettage, parenteral antibiotics, and catheter removal. Although this has been a reported complication of subclavian vein catheters, this is the first reported case associated with a Hickman catheter.

Glutathione peroxidase and selenium deficiency in patients receiving home parenteral nutrition: time course for development of deficiency and repletion of enzyme activity in plasma and blood cells

The time course for the depletion of red blood cell (RBC) and plasma glutathione peroxidase (GSHPx) activity in five patients receiving home parenteral nutrition was documented. During the development of the RBC GSHPx deficiency, enzymatic activity and protein content decreased. Plasma and RBC selenium content were similarly decreased as was cellular metabolism of exogenous hydrogen peroxide. When the replacement of Se (selenious acid) began, there was a rapid increase (within 6 h) in plasma GSHPx activity. Platelet and granulocyte (PMN) GSHPx activity, which were low when Se replacement began, became normal within a time consistent with the kinetics of platelet and PMN production. RBC GSHPx did not become normal for 3-4 mo. This is consistent with the time course for RBC production. It appears that the repletion of blood cell GSHPx requires the formation of these cells in the presence of Se.

Plasma Carnitine Levels in Patients Receiving Home Parenteral Nutrition B. A. BOWYER, C. R. FLEMING, D. ILSTRUP, J. NELSON, S. REEK, AND J. BURNES Am J Clin Nutr 43: 85–91, 1986

Plasma Carnitine Levels in Patients Receiving Home Parenteral Nutrition B. A. BOWYER, C. R. FLEMING, D. ILSTRUP, J. NELSON, S. REEK, AND J. BURNES Am J Clin Nutr 43: 85–91, 1986

Catheter-related septicaemia in patients receiving home parenteral nutrition.

Forty-three patients received home parenteral nutrition (HPN) for 4 to 13 months (median, 30 months) with a total treatment period of 153 patient-years. All patients had central venous catheters; 71 PVC subclavian catheters, 138 Broviac catheters, and 16 other catheters were used. Broviac catheters were introduced into the central veins via a tunnel on the chest (94 catheters) or on the thigh (44 catheters). Eighty-two episodes of catheter septicaemia occurred in 28 (65%) of the patients, corresponding to an incidence of catheter septicaemia of 1 in 1.9 patient-years. The commonest microorganisms grown from the blood were coagulase-negative staphylococci, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, and Candida species. Septicaemia incidence was 1 in 2.6 catheter-years with the Broviac catheter on the chest and 1 in 1.6 catheter-years with the Broviac catheter on the thigh. In 49 cases the patient was treated with both antibiotics and change of the catheters, in 26 cases with antibiotics alone, and in 5 cases with change of the catheter alone. The antibiotic therapy was given for 3 to 15 days (median, 7 days). No patient died of catheter septicaemia. The relapse rate was low (less than 10%) and did not differ significantly between the three treatment groups. It is concluded that catheter septicaemia is a common complication of HPN. In most cases it runs a mild course. Bacteriaemia can often be eradicated by a brief antibiotic therapy without catheter exchange.

Plasma carnitine levels in patients receiving home parenteral nutrition

Patients on long-term home parenteral nutrition (HPN) are known to frequently develop hepatic steatosis or steatohepatitis. The etiology of this steatosis or steatohepatitis is unknown, but carnitine deficiency has been one of the postulated mechanisms. The importance of L-carnitine in hepatic fatty acid oxidation and the steatosis observed in primary and acquired carnitine deficiencies prompted us to determine plasma carnitine levels in 37 patients receiving long-term HPN. Thirteen patients (35%) had low total and free plasma carnitine levels. Fifteen of the 37 HPN patients were matched for age and sex with 15 patients with Crohn’s disease who did not require HPN. Mean total and free plasma carnitine values were significantly lower (p < 0.001) in these 15 HPN patients (32.2 ± 11.9 and 28.4 ± 10.8) when compared to Crohn’s patients not requiring HPN (49.1 ± 10.9 and 46.4 ± 11.5). Associations were not detected between plasma carnitine and clinical or biochemical parameters that might have explained the low values.

Selenium status in patients receiving home parenteral nutrition.

Selenium (Se) status was evaluated in patients with intestinal failure requiring home parenteral nutrition (HPN). Ninety-two percent of patients (11 of 12) studied just prior to starting HPN had low serum Se values, and the mean value was 42 ng/ml, significantly less than mean values in disease controls with Crohn's disease not on HPN (76 ng/ml) and healthy controls (88 ng/ml). Eighty-five percent of patients (22 of 26) already on HPN for 2 to 109 months when studied had low serum Se levels (mean 38.4 ng/ml). The mean 24-hr urinary Se values were 3.7 micrograms in patients on HPN who did not have Crohn's disease, 10.9 micrograms in HPN patients with Crohn's, and 17.9 micrograms in healthy controls. In patients with Crohn's disease on HPN, a significant direct correlation existed between serum Se and the activity of whole blood glutathione peroxidase, a selenoprotein ; and a significant inverse correlation was found between serum Se and months of HPN. This study confirms that Se deficiency is very common in patients before starting and during HPN. These data and recent reports of cardiomyopathies associated with Se deficiencies in patients on HPN increase the importance of proper Se replacement and maintenance.

Priapism — A complication of home parenteral nutrition?

A case of priapism in a patient receiving home parenteral nutrition is reported. To our knowledge this is the first such case to occur in a patient receiving home parenteral nutrition. The literature is reviewed and the possible aetiology discussed.

P.35 Selenium status in patients receiving home parenteral nutrition (HPN)

P.35 Selenium status in patients receiving home parenteral nutrition (HPN)

Catheter-related complications in patients receiving home parenteral nutrition.

Twenty-seven patients (22 adults, five adolescents, and one child) were treated with home parenteral nutrition (HPN) for 662 patient-months. A Broviac Silastic right atrial catheter which is tunnelled subcutaneously down the anterior chest wall served as a venous access. Thirty-four catheters were used in 27 patients, and the mean catheter life spans to date for adults and adolescents have been 21 and 14 months, respectively. There were no deaths attributable to the catheters. Infections and damaged external catheter segments were clustered in adult patients, whereas serious mechanical problems occurred in adolescents. Five of 27 patients (19%) experienced septicemia and one patient had two episodes. These six episodes (five of Staphylococcus aureus, one of Candida parapsilosis) in 662 patient-months represented only one case of sepsis every 9.1 patient-years on HPN. The external segments of 12 catheters were damaged and all were repaired in the outpatient setting. Eight of nine major mechanical problems occurred in five adolescents and one child; the most serious being four intravascular displacements, one extravascular displacement with mediastinitis, and a fractured catheter with a retained intravascular catheter segment. Although the HPN catheter is associated with definite risks, there has been a very acceptable incidence of complications resulting in a high benefit-to-risk ratio for HPN.

Catheter-related Complications in Patients Receiving Home Parenteral Nutrition

Twenty-seven patients (22 adults, five adolescents, and one child) were treated with home parenteral nutrition (HPN) for 662 patient-months. A Broviac® Silastic right atrial catheter which is tunnelled subcutaneously down the anterior chest wall served as a venous access. Thirty-four catheters were used in 27 patients, and the mean catheter life spans to date for adults and adolescents have been 21 and 14 months, respectively. There were no deaths attributable to the catheters. Infections and damaged external catheter segments were clustered in adult patients, whereas serious mechanical problems occurred in adolescents. Five of 27 patients (19%) experienced septicemia and one patient had two episodes. These six episodes (five ofStaphylococcus aureus, one ofCandida parapsilosis) in 662 patient-months represented only one case of sepsis every 9.1 patient-years on HPN. The external segments of 12 catheters were damaged and all were repaired in the outpatient setting. Eight of nine major mechanical problems occurred in five adolescents and one child; the most serious being four intravascular displacements, one extravascular displacement with mediastinitis, and a fractured catheter with a retained intravascular catheter segment. Although the HPN catheter is associated with definite risks, there has been a very acceptable incidence of complications resulting in a high benefit-to-risk ratio for HPN.