Clinical Study of a Peripheral Total-Nutrients Admixture

Kim, Sung Heun; Lee, Yun Sik; Lee, Byung Chul

Abstract

BACKGROUND: We understand that central parenteral nutrition has a wide range of technical, metabolic, and septic complications and that lipid-based parenteral nutrition, like Total Nutrients Admixture (TNA), is more physiologic than glucose-based parenteral nutrition. Peripheral parenteral nutrition has become more convenient sinse the introduction of the TNA system and the development of large-bored silicon venous catheters. We have administered peripheral TNA (p-TNA) selectively to patients in whom central vein access is difficult or in whom central vein access is not required in case of surgical observation with conservative therapy for a certain period. We investigated the convenience and effectiveness of p-TNA in this study. METHOD:We evaluated retrospectively 50 patients to whom p-TNA had been administered at the Department of Surgery, Wallace Memorial Baptist Hospital, sometime during the year from Dec. 1996 to Nov. 1997. RESULT:In the Subjective Global Assessment (SGA) designed by Detskey et al. as a method of nutritional status assessment before administration of p-TNA, Class A was 24%, Class B was 64%, and Class C was 12%. Common indications for p-TNA were recent GI anastomosis in 19 cases (38%), acute pancreatitis in 8 cases (16%), and prolonged ileus or delayed gastric emptying in 6 cases (12%). Most patients were administered 1.5~2 L daily, and the maximal daily administered volume was 2.5 L. The mean duration of administration was 9.5 day, and no patients was administered p-TNA for longer than 2 weeks. Nutritional status indices, like body weight, transferrin, 24h-UUN, and lymphocyte count, were checked serially after administration of p-TNA. Nutritional status indices improved in above 80% of the cases. Clinical progress was improved in 86% of patients.
CONCLUSION
We believe p-TNA used under the proper indications to be efficacious and safe and to have fewer complications. The lipid, as the major calorie source is more physiologic, so p-TNA can supply patients with improved nutritional status easily.