Total Parenteral Nutrition Patients Research Articles

Safety and Efficacy of Initiating Parenteral Nutrition at Home, Home Start PN, in Advanced Peritoneal Metastasis.

Patients with peritoneal carcinomatosis often experience intestinal failure throughout the course of their disease, and total parenteral nutrition (TPN) can be used as a temporary solution or as a bridge to definitive cytoreductive surgery. Guidelines for TPN are well established for inpatients and in 2014, guidelines were established for the initiation of TPN for outpatients in a home setting. However, the safety and efficacy of home start TPN in advanced oncology patients remain unknown. This study aims to explore the safety and efficacy of starting TPN in the home setting for patients with peritoneal carcinomatosis. Health records of advanced cancer patients receiving TPN during 2009-2020 were retrospectively reviewed. Data pertaining to diagnosis, demographics, nutritional parameters, and outcomes including hospital readmission rates were collected. Safety was measured based on catheter-related complications and hospital admissions related to electrolyte or fluid imbalance due to TPN. Efficacy was determined by weight gain/stability and pre-albumin and albumin levels. The Fisher's exact and Kruskal-Wallis tests were used to analyze the data. Seventy TPN patients were identified, of which forty-two were home start (HS) and twenty-eight were in hospital (HP). The two groups were not significantly different in age, (HS: mean = 58.3 ± 13.9; HP: mean = 58.0 ± 13; p = 0.95), baseline body weight (p = 0.13), baseline albumin (p = 0.26) or pre-albumin (p = 0.48). At the end of treatment, the HS and HP groups had similar percentages of patients experiencing weight gain/stability (75% vs. 47%, p = 0.1), stable/increased pre-albumin (68% vs. 65%, p = 1), and stable/increased albumin levels (48% vs. 59%, p = 0.58). There was no difference in observed readmission between the groups (p = 0.79). At the end of treatment, 48% of the HS group and 36% of the HP group resumed an oral diet. This is the first study to present a comparison between home and hospital start TPN in advanced cancer patients, demonstrating that the initiation of outpatient TPN in the home setting is as safe and efficacious as TPN initiated in the hospital.

Total Parenteral Nutrition in Patients with Kidney Disease

Total Parenteral Nutrition in Patients with Kidney Disease

Enteral nutrition with medium-chain triglyceride compared to total parenteral nutrition in patient with chylothorax

Introduction: Chylothorax is associated with longer length of stay, higher morbidity, mortality, and hospitalization cost. The main principle of chylothorax therapy is to reduce the chylous flow. The current nutritional management of patients with chylothorax are a low fat diet with long chain triglyceride (LCT) restriction, enteral nutrition with high medium chain triglyceride (MCT), and total parenteral nutrition. However, low fat diet with LCT restriction takes quite a long time (around 3 weeks) and requires close monitoring due to risk for malnutrition, essential fatty acid, and micronutrient deficiencies. The nutritional management determines the success of conservative therapy in chylothorax patients. The aim of this study was to determine whether a high MCT enteral diet is more superior than total parenteral nutrition regarding the resolution of chylothorax.
 Method: Literature searching was conducted using advanced searching in three large databases: Pubmed, Science Direct, and ProQuest using eligibility criteria determined by the authors. Quality of evidences were assessed based on GRADE Guidelines. Level evidence was determined based on Oxford Center of Evidence-based Medicine (CEBM).
 Result: Three systematic reviews and one cohort met the PICO and eligibility criteria that had been set. Two studies concluded that enteral nutrition was better than parenteral nutrition. One study concluded that parenteral nutrition could be considered first and one study could not conclude which kind of nutrition was better.
 Conclusion: Administration of high MCT enteral nutrition can be the first line therapy in patients with chylothorax and still need close monitoring during the administration. One of the factors that need to be monitored is the daily production of chylothorax volume. The results shown by these studies are inconsistent and warrant further research of high-quality studies regarding the treatment of chylothorax.

Total parenteral nutrition for patients with gastrointestinal cancers: a clinical practice review.

The use of total parenteral nutrition (TPN) in patients with gastrointestinal cancers is a well-established practice, yet there is substantial variability in its use across institutions. Decision-making around the initiation of TPN is complex. An interdisciplinary team can help identify patient factors and clinical situations that influence whether a patient is likely to benefit from parenteral nutrition. We present the case of a woman with a gastrointestinal cancer who benefited from the initiation of TPN as a bridge therapy to further cancer treatment. This case highlights the importance of establishing a plan for nutrition with specific goals in mind, such as optimizing patients for more cancer-directed therapy. Although patients with gastrointestinal cancers may be candidates for TPN, many patient-specific factors, such as functional status and opportunities for future treatments, must be considered prior to the initiation of parenteral nutrition. An interdisciplinary approach should be used to make recommendations based on patient goals, with a focus on patient and cancer characteristics that are associated with positive outcomes after initiation of TPN. These characteristics include functional status, nutritional status, degree of symptom control, and ability to safely administer nutrition. It is important to continually assess whether parenteral nutrition is beneficial in respect to a patient's preferences and prognosis.

FTP4.3 Improving awareness of total parenteral nutrition administration in general surgical patients: a tertiary care hospital experience

Abstract Introduction Dieticians on the general surgical ward are valuable in providing recommendations to optimise patient nutrition, including the administration of total parenteral nutrition (TPN). Prescribing TPN is time-intensive as patients' clinical status and biochemical profile are assessed to avoid re-feeding syndrome. This needs adjustment of the dieticians’ recommendations, highlighting the importance of clinician awareness of patients recommended for TPN. Methods We carried out a quality improvement project (QIP) on the general surgical ward of a tertiary centre teaching hospital which involved two plan-do-study-act (PDSA) cycles. We used primary and secondary qualitative surveys to collect data. In the first cycle, we implemented a daily whiteboard handover system in the doctors’ office which displayed the patients recommended for TPN. In the second cycle, we added a TPN recommendation section to the daily patient handover / ward patient list. Results Pre-intervention respondents reported lack in awareness of patients recommended for TPN, and felt prescription was often delayed. Use of a whiteboard was well accepted by junior doctors as well as dieticians and improved awareness of patients on TPN. However, this duplicated the workload and information sources for dieticians and doctors. Use of the patient handover list resulted further improved awareness and subsequently quicker timeliness of TPN prescribing. Conclusions Both whiteboard displays & highlighting the potential TPN patients in the handover lists were well-accepted and effective ways to improve awareness of patients on TPN. Sustainable interventions should not result in duplication of workload or information. Future work could include quantitative analysis of the above interventions.

Molecular Oxygen Levels and Percentages of DNA Damage in TPN Patients

Total parenteral nutrition (TPN) is a life-saving therapy for patients with intestinal failure, but it carries the risk of complications, including an increase in liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) after long-term use. Patients receiving chronic TPN are also exposed to metabolic stress from both the underlying disease and parenteral nutrition. The aim of this study was to compare the concentration of liver transaminases AST and ALT in relation to the rate of oxygen consumption in platelet mitochondria in patients receiving long-term TPN with the degree of oxidative stress induced by lipid emulsions, and to explain their role in cellular energy metabolism and changes in the liver based on the percentage of genomic DNA damage. The study group consisted of 86 TPN patients, while the control group consisted of 86 healthy volunteers who were fed only orally. The results of the study showed that the percentage of molecular oxygen depended on the type of lipid emulsion supplied. Analyzing time on TPN as a factor, we observed a decrease in percentage genomic DNA damage and an increase in percentage molecular oxygen in cells. It remains unclear whether TPN has a direct effect on genomic DNA damage and the level of molecular oxygen in cells during the course of treatment. In conclusion, this study provides important insights into the potential effects of TPN on liver enzymes and cellular metabolism. Further research is needed to better understand the underlying mechanisms and to develop strategies to minimize the risk of complications associated with TPN.

Total parenteral nutrition is associated with worse hospital outcomes among elderly diabetic patients: a propensity score matched analysis on discharge records.

Recent trials and reviews have raised question about the safety of total parenteral nutrition (TPN), due to the increased rate of TPN related complications. Diabetic patients are vulnerable to hyperglycaemia, and poor studies have investigated hospital out-comes of diabetic patients requiring TPN. The aim of this study was to evaluate the association of in-hospital mortality, prolonged length of stay and transfer to long-term care facilities among diabetic patients with TPN. The study considered all hospital admissions of diabetic patients over 65 years of age performed between 2006 and 2015 in Abruzzo Region, Italy. To compare the outcomes of TPN and non-TPN patients, a propensity score matching procedure was performed. A total of 140,556 admissions were analyzed. After matching, 1947 patients were included into the analyses: 649 patients with TPN and 1298 controls. TPN was significantly associated to in-hospital mortality (OR=7.15; 95%CI 5.54-9.22), prolonged LOS (OR=2.78; 95%CI 2.28-3.38) and transfer to LTCF (OR=2.16; 95%CI 1.64-2.85). TPN is associated with poor outcomes among elderly diabetic patients in the Italian setting. Being aware of the risk factors among diabetic patients with TPN can be used to anticipate the patients' needs during the admission and the immediate post-discharge period.

Paralytics and Total Parenteral Nutrition Predict Post-Heart Transplant Mortality in Infants

<h3>Purpose</h3> Many have discussed the perils of "limping to transplant" & have identified risk factors associated with poor heart transplant (HTx) survival. We sought to determine the effect of total parenteral nutrition (TPN)-dependence & paralytics on HTx survival. <h3>Methods</h3> UNOS & PHIS data were used to identify infants listed for HTx (1996-2020) on mechanical ventilation (MV; ≥2 consecutive days pre-HTx), paralytics (insurance-charge on ≥3/5 days pre-HTx), &/or TPN-dependent (insurance-charge for TPN on ≥3/5 days pre-HTx; no charges for oral nutrition on 5/5 days). <h3>Results</h3> 1,425 patients were identified: MV (n=355), paralytics (n=132), and/or TPN (n=351). DCM was more common in those on MV & paralytics, whereas TPN patients had more organ dysfunction & ECMO (p<0.01 for all; Table). 1-year mortality was independently predicted by MV (HR 1.5 (95% CI 1.1-2.0), p=0.01), paralytics (1.8 (1.2-2.8), p<0.01), & TPN (1.6 (1.2-2.2), p<0.01). Requirement for all three was the greatest predictor of mortality (2.3 (1.2-4.4), p<0.01), whereas requirement of none was protective (0.6 (1.2-2.2), p<0.01). As mutually exclusive groups, MV did not independently predict mortality compared to no-support (1.4 (0.9-2.3), p=0.14) or all others (0.7 (0.7-1.7), p=0.69) but all other combinations of TPN, MV, & paralytics were predictive of mortality (p≤0.03 for all; Figure). <h3>Conclusion</h3> Paralytics &/or TPN at transplant independently predicted mortality in infants following HTx. Surprisingly, MV alone was not predictive, although over half of patients on MV were also on paralytics or TPN. This study demonstrates the complexity of what it means to "limp to transplant."

A249 RETROSPECTIVE CHART REVIEW OF PATIENTS WITH MALNUTRITION REQUIRING ADVANCED NUTRITIONAL SUPPORT POST BARIATRIC SURGERY

BackgroundObesity is a global pandemic with a steady increase in global BMI since 1975. Bariatric surgery is an effective treatment for patients with severe obesity in order to sustain long-term weight loss and reduce comorbidity burden and mortality associated with obesity. However, post-bariatric surgery patients face nutritional complications ranging from micronutrient deficiencies to intestinal failure requiring total parenteral nutrition (TPN). From our institution of home TPN patients, 6.4% of patients had bariatric surgery. Intestinal failure is a burdensome diagnosis for patients, and there is a paucity of literature characterizing patients post-bariatric surgery who develop intestinal failure.AimsWe aim to identify the patient characteristics, surgical details, and nutritional traits that predisposed patients to developing intestinal failure requiring advanced nutritional support.MethodsThis is a retrospective chart review of 48 patient admitted to the Royal Alexandra Hospital post-bariatric surgery for nutritional support and followed by the TPN program dieticians and nurses.ResultsOur results show the mean BMI was 49.94 kg/m2 pre-bariatric surgery. Interestingly, the mean BMI at time of hospitalization for bariatric-surgery related complications was 33.210 kg/m2 which is classified as overweight but most of patients were severely malnourished with SGA C (43.8%), SGA B (29.17%), and 8.3% were SGA A. Patients requiring parenteral nutrition post-bariatric surgery are mostly female, developed barriers to oral intake, 15% engaged in medical tourism, 58.3% had an underlying mental health diagnosis, and only 18.8% were on a multivitamin even though it is standard of post-bariatric surgery care. The time between initial bariatric surgery to hospital admission was 11.2 years, and most required ≥1 revisional surgery. The mean age at bariatric surgery was 33.2-years old and the average age at initial hospitalization was 48.9-years old. Patients requiring ≥2 admissions had vertical band gastroplasty or sleeve gastrectomy (both 36.8%) while 21.1% had Roux-en-Y gastric bypass. Of these patients, 39.6% of patients required ≥2 hospital admissions and the mean total days spent in hospital was 57.15 days. While these complications are uncommon, these patients result in multiple prolonged hospitalizations and can be difficult to manage.ConclusionsOverall, the results of our study will allow the multidisciplinary teams that care for post-bariatric surgery patients to identify patients at risk of intestinal failure and potentially intervene with early enrollment into home nutrition program. With increasing awareness, patients at higher risk can be closely monitored in order to prevent micronutrient deficiencies before they progress to intestinal failure and require lifetime parenteral nutrition.Funding AgenciesNone

Efficacy of early enteral nutrition versus total parenteral nutrition for patients with gastric cancer complicated with diabetes mellitus: A systematic review and meta-analysis.

This study aimed to synthesise available data and evaluate the clinical evidence regarding the effect of early enteral nutrition versus total parenteral nutrition on nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after gastrectomy. This systematic review and meta-analysis was designed, conducted and reported following the PRISMA guideline. We performed searches in PubMed, Embase, Medline, Web of Science, Cochrane Library, Chinese Biomedicine Literature Database, Chinese Scientific Journal Database, Chinese National Knowledge Infrastructure and Wanfang Database. The study designs were randomised controlled trials, quasi-randomised controlled trials, and controlled clinical trials. The trials compared early enteral nutrition (experimental group) with total parenteral nutrition (control group) in patients with gastric cancer complicated with diabetes mellitus after gastrectomy. The risk of bias was assessed using the Cochrane risk of bias tool. A total of 19 trials (1255 patients) were included. Meta-analysis showed a significantly shorter length of hospital stay (days; mean difference-5.07, 95% confidence interval [CI] [-6.28, -3.86], p < 0.00001) and a lower post-operative complications rate (%; odds ratio0.29, 95% CI [0.16, 0.50], p < 0.0001) in the early enteral nutrition group than in the total parenteral nutrition group. Compared with the total parenteral nutrition group, the early enteral nutrition group had lower blood glucose fluctuation values (mmol/L; mean difference-2.03, 95% CI [-2.44, -1.61], p < 0.00001), lower levels of glycosylated haemoglobin (%; mean difference -0.62, 95% CI [-1.22, -0.03], p=0.04), higher levels of prealbumin (g/L; p=0.002), transferrin (g/L; p=0.002), total protein (g/L; p=0.001) and haemoglobin (g/L; p=0.005). Early enteral nutrition may maintain stable blood glucose levels and improve nutritional status, leading to better therapeutic effectiveness in gastric cancer complicated with diabetes mellitus patients.

The outcome and complications of total parenteral nutrition in pediatric hematopoietic stem cell transplantation.

Nutritional support posthematopoietic stem cell transplantation (HSCT) with total parenteral nutrition (TPN) or nasogastric tube feeding (NGT) in pediatric patients is associated with benefits and risks. We retrospectively reviewed the indication of TPN use in our pediatric HSCT patients and its impact on survival and possible related complications. A total of 228 HSCTs were performed during the study period. TPN was used in 144 patients (63.2%) for a median of 14days, while 8.8% had NGT feeding and 28% were able to tolerate oral feeding. Severe mucositis was seen in 104 TPN patients (72.2%) in comparison with 22 patients (26.2%) who were on Enteral Nutrition (EN) (p=<.001). Sinusoidal obstruction syndrome (SOS) was seen in 19 (13.2%) patients who had TPN compared to none in the patients who received EN (p=.001). The majority of patients who had SOS received myeloablative conditioning (MAC) therapy for hemoglobinopathy. Acute graft-versus-host disease (aGVHD) was seen in 24.8% of TPN patients and 9.1% of non-TPN patients (p=.01). However, there were no statistically significant differences in chronic GVHD, bacteremia, and patients' survival between both groups. TPN is commonly used after pediatric HSCT in cases of severe mucositis. NGT feeding was found to be the least used nutritional support method. SOS and aGVHD were associated more frequently in TPN patients compared to EN patients. This suggests the possible disadvantages of TPN and importance of SOS preventative measures in high-risk patients.

The Role of Total Parenteral Nutrition in Patients with Peritoneal Carcinomatosis: A Systematic Review and Meta-Analysis.

Simple SummaryPatients with peritoneal carcinomatosis often develop complications which prevent them from receiving adequate oral intake. This can contribute to malnutrition, as well as increased morbidity and mortality. In such patients, total parenteral nutrition, which involves the intravenous administration of nutrients thereby bypassing the oral route, can be lifesaving. In this study, we performed a systematic review and meta-analysis of the existing literature to evaluate the effect of total parenteral nutrition on the survival of patients with peritoneal carcinomatosis. In light of the limited treatment options available, total parenteral nutrition may improve survival outcomes, but further studies are needed to conclude definitively.Peritoneal carcinomatosis (PC) is often associated with malnutrition and an inability to tolerate enteral feeding. Although total parenteral nutrition (TPN) can be lifesaving for patients with no other means of nutritional support, its use in the management of PC patients remains controversial. Therefore, a systematic review and meta-analysis was performed to evaluate the benefit of TPN on the overall survival of PC patients, in accordance with PRISMA guidelines. A total of 187 articles were screened; 10 were included in this review and eight were included in the meta-analysis. The pooled median overall survival of patients who received TPN was significantly higher than patients who did not receive TPN (p = 0.040). When only high-quality studies were included, a significant survival advantage was observed in PC patients receiving TPN (p < 0.001). Subgroup analysis of patients receiving chemotherapy demonstrated a significant survival benefit (p = 0.008) associated with the use of TPN. In conclusion, TPN may improve survival outcomes in PC patients. However, further studies are needed to conclude more definitively on the effect of TPN.

Venous Thrombosis of the Mammary Vein Following Peripherally Inserted Central Catheter for Total Parenteral Nutrition Relying on Ecg Tip Confirmation Technology

Total parenteral nutrition (TPN) is a life-saving therapy for patients who are not able to utilize the gastrointestinal tract. There are several different types of central venous catheters (CVC) used to deliver TPN. To safely deliver hyperosmotic TPN solutions, CVC tip position should be in the in lower superior vena cava (SVC) or at the junction of SVC and right atrium (RA). New techniques such as intravascular electrocardiogram (ECG) are being used for tip confirmation to help facilitate expedient use of PICC lines replacing the need for chest x-ray (CXR) confirmation. We present a case of a TPN patient who had a PICC line placed, and ECG confirmed tip as being in the SVC. The patient developed chest pain with flushing of the PICC prompting surgical service to obtain a CXR. The CXR suggested the line was in the either in mammary vein or aorta and recommended replacement. Interventional radiology flushed a small amount of contrast through the PICC and fluoroscopy confirmed the PICC tip was in the left internal mammary vein with reflux of contrast in the left innominate vein. The left innominate vein was occluded due to thrombosis and vasospasm. The patient required increased level of care (PCU) for 2 days, but was eventually discharged with home total parenteral nutrition and has done well. We conclude that care should be taken when using ECG confirmation for PICC tip placement and we feel that patients requiring hyperosmotic TPN should still require CXR confirmation to ensure tip appropriate tip location.

The Perimetric Protuberance-Periosteal Chondroma

Total parenteral nutrition (TPN) is a life-saving therapy for patients who are not able to utilize the gastrointestinal tract. There are several different types of central venous catheters (CVC) used to deliver TPN. To safely deliver hyperosmotic TPN solutions, CVC tip position should be in the in lower superior vena cava (SVC) or at the junction of SVC and right atrium (RA). New techniques such as intravascular electrocardiogram (ECG) are being used for tip confirmation to help facilitate expedient use of PICC lines replacing the need for chest x-ray (CXR) confirmation. We present a case of a TPN patient who had a PICC line placed, and ECG confirmed tip as being in the SVC. The patient developed chest pain with flushing of the PICC prompting surgical service to obtain a CXR. The CXR suggested the line was in the either in mammary vein or aorta and recommended replacement. Interventional radiology flushed a small amount of contrast through the PICC and fluoroscopy confirmed the PICC tip was in the left internal mammary vein with reflux of contrast in the left innominate vein. The left innominate vein was occluded due to thrombosis and vasospasm. The patient required increased level of care (PCU) for 2 days, but was eventually discharged with home total parenteral nutrition and has done well. We conclude that care should be taken when using ECG confirmation for PICC tip placement and we feel that patients requiring hyperosmotic TPN should still require CXR confirmation to ensure tip appropriate tip location

A Comparative Study Evaluating Improvements in Nutritional Status by Oral and Enteral Versus Parenteral Nutrition in Elderly Inpatients of an Emergency Hospital

Aim: Elderly patients hospitalized in the internal medicine department who do not have sufficient oral nutritional intake and fall into low nutrition require artificial hydration and nutrition. Here, the effectiveness of total parenteral nutrition (TPN) was compared to the nutritional administration methods for discharged patients. Methods: 508 elderly inpatients who were admitted to the internal medicine department of an emergency hospital and administered TPN over 9 years were divided into two groups: patients who were discharged (331) and those who died in the hospital (177). Patients were further divided into four groups at the time of discharge from the hospital: oral nutrition, enteral nutrition, peripheral parenteral nutrition and TPN. The effectiveness of TPN was evaluated using serum albumin level and the COntrolling NUTrition Status Score (CONUT) nutritional evaluation tool. Results: While the nutritional status of patients of oral and enteral nutrition improved upon discharge, the CONUT of TPN patients without oral or enteral nutrition did not improve and serum albumin levels of the patients deteriorated. Conclusion: To discharge patients alive and safe, efforts must be made to continue oral and enteral nutrition for as long as possible.

Clinical Characteristics and Outcomes of S. Aureus Bacteremia in Patients Receiving Total Parenteral Nutrition.

Background: Patients on total parenteral nutrition (TPN) are at risk of developing central line-associated infections. Specifically, Staphylococcus aureus bacteremia (SAB) is feared for its high complication rates. This prospective cohort study compares characteristics, clinical course and outcome of SAB in patients with and without TPN support. Methods: Clinical and microbiological data from all patients with positive blood cultures for S. aureus from two facilities, including our referral center for TPN support, were retrieved (period 2013–2020). Primary outcome was overall mortality, and included survival analysis using a multivariate Cox regression model. Secondary outcomes comprised a comparison of clinical characteristics and outcomes between both patient groups and analysis of factors associated with complicated outcome (e.g., endocarditis, deep-seated foci, relapse and death) in patients on TPN specifically. Results: A total of 620 SAB cases were analyzed, of which 53 cases received TPN at the moment the blood culture was taken. Patients in the TPN group were more frequently female, younger and had less comorbidity (p < 0.001). In-hospital death and overall mortality were significantly lower in TPN patients (4% vs. 18%, p = 0.004 and 10% vs. 34%, p < 0.001, respectively). Positive follow-up blood cultures, delayed onset of therapy and previous catheter problems were associated with a higher incidence of complicated SAB outcome in patients on TPN. Conclusion: Our data show that patients on TPN have a milder course of SAB with lower mortality rates compared to non-TPN SAB patients.

Iron deposition in autopsied liver specimens from older patients receiving intravenous iron infusion.

Vitamins and minerals are routinely administered by total parenteral nutrition (TPN). However, in Japan, adjustments in iron dosage are difficult because blended mineral preparations are often used. It is therefore unclear whether the iron content is appropriate in cases of long-term TPN. The aim of the study was to assess the influence of iron administration by long-term TPN on iron deposition in post-mortem liver samples isolated from older deceased patients. Liver tissues were collected from post-mortem autopsies of 187 patients over a period of 15 years. Samples were stained with Prussian blue and histologically evaluated from Grade 0-V by at least three different observers. Specimens with positive and negative iron staining were compared, and positive samples were grouped according to the level and distribution of the staining. Post-mortem blood obtained from the subclavian vein during autopsy was also analysed. Samples were collected for the measurement of unsaturated serum iron, serum iron, albumin, prealbumin, hepcidin, and IL-6 concentrations. Iron accumulation in the liver was significantly higher in male patients (p = 0.005) with a history of surgery (p = 0.044) or central vein administration of iron (p<0.001). Additionally, the duration of TPN in the iron-positive group was significantly longer than in the iron-negative group (p = 0.038). Serum analysis revealed that unsaturated serum iron was significantly higher in the iron-negative group and that ferritin and serum iron were significantly higher in the iron-positive group. No other statistically significant differences were observed between the two groups. Chronic intravenous administration of iron was associated with iron deposition in the liver, even when given the minimum recommended dosage. In long-term TPN patients, the iron dose should therefore be carefully considered.

1042-P: Insulin Requirement during Total Parenteral Nutrition in Patients with Diabetes Mellitus

Glycemic control in patients with diabetes mellitus receiving total parenteral nutrition (TPN) can be challenging due to multiple factors. These patients often have a high burden of illness and receive medications that raise blood glucose (BG) levels. Moreover, TPN delivers a large amount of glucose directly into the systemic circulation without the benefit of incretin effect. Therefore, relatively large amounts of insulin are expected to be required for glycemic control. However, there are no studies to guide insulin dosing in patients with diabetes being started on TPN. We conducted a retrospective study including all patients with diabetes admitted to our hospital over a 1-year period who received TPN for ≥ 3 days. The goal of this study was to estimate a safe starting dose of insulin for TPN. Patients receiving enteral nutrition along with TPN were excluded. Insulin doses and blood glucose levels on the last day of TPN were used for data analysis. We found 25 patients who fulfilled our inclusion/exclusion criteria. All patients had type 2 diabetes and were receiving antidiabetic drugs before hospitalization. Mean age was 68 ± 7 years, 56% were men, 80% were White, 44% had microvascular and 44% had macrovascular complications. Mean BMI was 26.7 ± 6.7 kg/m2, systolic BP 131 ± 27 mmHg, diastolic BP 65 ± 15 mmHg, HbA1c 7.7 ± 2.3% and serum creatinine 2.7 ± 3.3 mg/dl. The mean daily BG on TPN was 212 ± 47 mg/dl. Out of 171 BG values available on the last day of TPN, 116 (68%) were &amp;gt;180 mg/dl, 4 (2%) were &amp;lt;70 mg/dl and 0 were &amp;lt;40 mg/dl. Only two patients suffered mild hypoglycemic episodes while all others remained hyperglycemic. Average total daily insulin dose was 17 ± 20 units before starting TPN and 53 ± 54 units on the last day of TPN. Patients received an average of 0.7 Units/kg total daily dose of insulin on the last day of TPN. With this dose, they had minimal risk of hypoglycemia but the glucose levels were often high. Our study shows that the majority of patients with diabetes need more than 0.7 units/kg insulin when receiving TPN. Disclosure R. Garg: None. A. Arunachalam: None. L.E. Bermudez: None. M. Ramirez: None.

Prevalence and Risk Factors of Total Parenteral Nutrition Induced Hyperglycemia at a Single Institution: Retrospective Study.

Background: Total parenteral nutrition (TPN) provides full nutrition support to critically ill patients with an impaired digestive tract. Patients who receive TPN support are at higher risk for complications such as hyperglycemia. In our study, we aim to assess the prevalence of hyperglycemia induced by TPN and identify its risk factors in hospitalized adult patients.Methods: Patients who received TPN between January 2012 and December 2017 at University of Pittsburgh Medical Center—St. Margaret hospital were retrospectively screened. TPN-induced hyperglycemia was confirmed whether blood glucose was ≥180 mg/dL at any point, from the time of TPN initiation until 1-day post TPN termination. Characteristics of the hyperglycemia and the nonhyperglycemia groups were analyzed to predict potential risk factors.Results: A total of 197 patients were screened, 55 were excluded (1 died, 37 diabetic, and 17 had elevated blood glucose before TPN), and 142 patients were included, 42 of them (29.6%) developed hyperglycemia following TPN administration. Duration of TPN, surgical indications, and obesity were significantly higher in the hyperglycemia group. Additionally, age and steroids use were independent predictors of hyperglycemia in TPN patients after applying multivariable logistic regression model on our sample.Conclusions: Hyperglycemia is common after TPN. Risk factors assessment may help optimizing glycemic control in higher risk individuals to improve their outcomes. These include patients with obesity, surgical indication of TPN, and longer duration of TPN.

P2.23: New alternative to antibiotics: 4% Tetrasodium EDTA is a non-antibiotic antimicrobial solution effective against Canadian microorganisms and associated biofilms found in central venous access devices of total parenteral nutrition patients

P2.23: New alternative to antibiotics: 4% Tetrasodium EDTA is a non-antibiotic antimicrobial solution effective against Canadian microorganisms and associated biofilms found in central venous access devices of total parenteral nutrition patients