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John Macfie - One of the best experts on this subject based on the ideXlab platform.

  • Peripheral Parenteral Nutrition.
    British Journal of Surgery, 2003
    Co-Authors: A. D. G. Anderson, D Palmer, John Macfie
    Abstract:

    Background: Peripheral Parenteral Nutrition (PPN) currently accounts for almost 20 per cent of all Parenteral Nutrition administered in the UK. In the absence of consensus guidelines there is wide variation in practice. Heterogeneity of clinical trials has made direct comparisons difficult and meta-analysis impossible. Methods: Medline, Embase and Cochrane databases were searched for all clinical trials relating to the use of PPN in adults. Relevant papers from the reference lists of these articles and from the authors' personal collections were also reviewed. Results and conclusions: Effective PPN is possible in about 50 per cent of inpatients requiring Parenteral Nutrition. Evidence relating to optimal feed composition, choice of cannula, infusion technique and pharmacological manipulation is discussed, along with practical recommendations for the administration of PPN. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  • Prospective study of the aetiology of infusion phlebitis and line failure during Peripheral Parenteral Nutrition
    The British journal of surgery, 1996
    Co-Authors: J. May, John Macfie, D Palmer, P.m. Murchan, P. C. Sedman, R. Donat, C.j. Mitchell
    Abstract:

    Four techniques of administering Peripheral Parenteral Nutrition (PPN) were examined prospectively to investigate the role of mechanical trauma in the development of infusion phlebitis. Patients in group 1 (n = 15) were fed via a standard 18-G Teflon cannula which was removed on completion of the infusion and was rotated to the contralateral arm every day. Group 2 patients (n = 15) had a similar catheter sited in each forearm simultaneously, with rotation of the side of infusion each day. Patients in group 3 (n = 17) had a 15-cm Silastic rubber catheter inserted into a forearm vein and a standard cannula sited in the contralateral forearm, with alternation of infusion each day. Those in group 4 (n = 13) had a fine-bore 23-G silicone catheter sited in one arm only. Patients in groups 1, 2 and 3 were fed over 12-h cycles and those in group 4 for a 24-h continuous cycle. A total of 408 patient-days of PPN were given. Mean duration of PPN in groups 1-4 was 7.5, 9, 5.5 and 5 days respectively. Infusion phlebitis was not recorded in patients who had a daily change of cannula (group 1), but occurred in four patients in group 2, eight in group 3 and eight in group 4. Phlebitis scores were 0, 9, 15 and 12 for groups 1-4 respectively. Severe phlebitis and line occlusion occurred more frequently in patients with a 15-cm catheter (group 3) and in those fed continuously over 24 h (group 4). These results suggest that mechanical trauma is an important factor in the aetiology of infusion phlebitis. This can be minimized by reducing the time for which the vein wall is exposed to nutrient infusion and by reducing the amount of prosthetic material within the vein.

  • Administration of Peripheral Parenteral Nutrition: a prospective study comparing rotation of venous access sites with ultrafine cannulas.
    Clinical nutrition (Edinburgh Scotland), 1996
    Co-Authors: D Palmer, John Macfie, P.m. Murchan, I.m. Bradford, J.d. Harrison, C.j. Mitchell
    Abstract:

    Peripheral veins have been used successfully for patients requiring short- to medium-term total Parenteral Nutrition. This study prospectively compares two methods of Peripheral Parenteral Nutrition (PPN). Forty-six patients requiring Parenteral Nutrition (PN) were identified prospectively. Fifty courses of PPN were prescribed using a standardized PPN formula of 9.3 g nitrogen, 1400 kCal, 2500 ml (KABI II, Pharmacia). Patients were randomized to receive PPN via 23G, 15 cm flexane catheters (Nutriline) inserted into an antecubital vein which remained in-situ with a continuous infusion over 24 h, or to receive 12-h cyclical infusions through Peripherally sited 18G catheters (Venflon) which were removed postinfusion and reinserted into the contralateral forearm on alternate days. Data collected included duration, complications and cost of materials for each prescribed course. A scoring system to determine patient anxiety and depression and a questionnaire regarding patients' perspectives were evaluated. Fifty courses were prescribed, 26 by rotation of veins (RV) and 24 by Nutriline (N). Mean duration of feeding was 7.9 and 8.6 days, respectively; cost of materials were comparable 6.48/day (RV) vs 5.17/day (N); 2 RV patients failed to complete their course (no access [P< 0.05], whilst 9 N patients failed to complete their course (4 severe phlebitis, 2 no venous access, 2 septicaemia, 1 dislodged). Five patients required CPN (RV, N 3) while 4 remaining patients were fed by an alternative PPN method. The overall incidence of anxiety was 20% and of depression 16%, with no significant difference between groups. The majority of patients (87%) found mobility restricted. Twelve-hourly infusions via alternate forearm veins were significantly more successful than continuous infusions via Nutriline, both in terms of completion of the prescribed course and less venous morbidity. This study confirms that rotation of forearm veins allows affordable and successful PN administration to the majority of patients, with low PN-related morbidity.

  • A prospective and randomised study comparing the incidence of infusion phlebitis during continuous and cyclic Peripheral Parenteral Nutrition.
    Clinical nutrition (Edinburgh Scotland), 1991
    Co-Authors: M.j. Kerin, C.j. Mitchell, I.r. Pickford, H J Jaeger, N.f. Couse, John Macfie
    Abstract:

    Phlebitis is a major obstacle to successful and prolonged Peripheral Parenteral Nutrition (PPN). This study evaluated the effects of elective changes of the intravenous cannula and cyclic infusion of PPN on the incidence and the severity of phlebitis. 51 consecutive patients requiring PPN were randomised into three groups. Group 1 received PPN continuously through a line which was changed only on evidence of phlebitis. In Group 2 intravenous lines were changed every 24h. Group 3 patients received PPN as a 12-h infusion after which the intravenous cannula was withdrawn. All patients received 1800 non-protein calories and 9.4g nitrogen daily. Infusion sites were assessed daily for phlebitis and this was scored using a modified Maddox scale. The mean (range) duration of PPN was 7.5 (1-13), 10.0 (2-42) and 8.2 (3-14) days in the three groups respectively. Severe phlebitis occurred more frequently (p < 0.05) in Group 1 compared to Group 2 or Group 3. The overall incidence of phlebitis assessed from the mean value of the Maddox scores for each group was highest in Group 1 and was significantly greater than that observed in either Group 2 (p < 0.05) or Group 3 (p < 0.001). Group 3 patients who received cyclic PPN had the lowest incidence of phlebitis. The results of this study suggest that the incidence of infusion phlebitis is minimised during PPN by the cyclic infusion of nutrient solutions.

Jesús M. Culebras - One of the best experts on this subject based on the ideXlab platform.

  • Peripheral Parenteral Nutrition
    Revista de medicina de la Universidad de Navarra, 2006
    Co-Authors: Jesús M. Culebras, Gonzalo Martin-peña, A. García De Lorenzo, José Antonio Rodríguez-montes
    Abstract:

    The Target of this review is to provide an up-to-date overview of the advantages and disadvantages of Peripheral Parenteral Nutrition (PPN), including techniques, indications and results. The new generation catheters, together with a better knowledge of the intermediary metabolism, give us the opportunity to use PPN in many clinical situations for short periods of time. PPN is an alternative to Total Parenteral Nutrition (TPN) and is also a complement to enteral Nutrition and to the oral route. Progress in the design of catheters and their materials, in infusion techniques and better knowledge of optimal nutrients has made PPN into an effective, safe and useful therapy in the treatment of patients for certain periods of time.

  • Practical aspects of Peripheral Parenteral Nutrition.
    Current Opinion in Clinical Nutrition and Metabolic Care, 2004
    Co-Authors: Jesús M. Culebras, Gonzalo Martin-peña, Abelardo García-de-lorenzo, A. Zarazaga, José Antonio Rodríguez-montes
    Abstract:

    PURPOSE OF REVIEW: The purpose of this review is to provide an update on the advantages and disadvantages of using Peripheral Parenteral Nutrition, including the techniques, indications and results. RECENT FINDINGS: The new catheters, together with a better knowledge of intermediate metabolism, permit the use of Peripheral Parenteral Nutrition in many clinical situations during short periods of time. SUMMARY: Peripheral Parenteral Nutrition is an alternative to total Parenteral Nutrition, and is a complement to enteral Nutrition and the oral route. Progress in catheter design and materials, infusion techniques and an improved knowledge of the optimal nutriments has made Peripheral Parenteral Nutrition a safe, efficient and useful method to treat patients over certain periods of time.

  • Practical aspects of Peripheral Parenteral Nutrition.
    Current opinion in clinical nutrition and metabolic care, 2004
    Co-Authors: Jesús M. Culebras, Gonzalo Martin-peña, Abelardo García-de-lorenzo, A. Zarazaga, José Antonio Rodríguez-montes
    Abstract:

    Purpose of reviewThe purpose of this review is to provide an update on the advantages and disadvantages of using Peripheral Parenteral Nutrition, including the techniques, indications and results.Recent findingsThe new catheters, together with a better knowledge of intermediate metabolism, permit th

  • Antipyrine clearance in surgical patients maintained on hypocaloric Peripheral Parenteral Nutrition.
    JPEN. Journal of parenteral and enteral nutrition, 1994
    Co-Authors: Francisco Jorquera, Jesús M. Culebras, Mar Almar, Carlos Martinez, M. González-sastre, Javier Gonzmel-gmiego
    Abstract:

    Backgyound: Antipyrine clearance (CLAP) constitutes a sensitive indicator of hepatic microsomal enzyme activity providing specific information on hepatic function. The purpose of this study was to evaluate the influence of hypocaloric Peripheral Parenteral Nutrition on CL AP in patients receiving Nutrition support after elective surgery. Methods: CLAP was measured in 15 patients before elective gastrointestinal surgery and 6 days after the surgery. Antipyrine (1 g) was administered orally, and CLAP was determined by the one-sample method. Subjects received a postoperative 786 kcal/d regimen providing 66 g of amino acid per day and 133 g of glucose per day for 5 days. Nutritional status was evaluated by anthropometric parameters. A control group of 15 patients received no postoperative hypocaloric Peripheral Parenteral Nutrition but received conventional fluid therapy. Results: Mean CLAP was increased by 61% (0.66 ± 0.06 mL/min·kg-1 body wt vs 0.41 ± 0.05 mL/min·kg-1 body wt in the preoperative period; p

D Palmer - One of the best experts on this subject based on the ideXlab platform.

  • Peripheral Parenteral Nutrition.
    British Journal of Surgery, 2003
    Co-Authors: A. D. G. Anderson, D Palmer, John Macfie
    Abstract:

    Background: Peripheral Parenteral Nutrition (PPN) currently accounts for almost 20 per cent of all Parenteral Nutrition administered in the UK. In the absence of consensus guidelines there is wide variation in practice. Heterogeneity of clinical trials has made direct comparisons difficult and meta-analysis impossible. Methods: Medline, Embase and Cochrane databases were searched for all clinical trials relating to the use of PPN in adults. Relevant papers from the reference lists of these articles and from the authors' personal collections were also reviewed. Results and conclusions: Effective PPN is possible in about 50 per cent of inpatients requiring Parenteral Nutrition. Evidence relating to optimal feed composition, choice of cannula, infusion technique and pharmacological manipulation is discussed, along with practical recommendations for the administration of PPN. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  • Prospective study of the aetiology of infusion phlebitis and line failure during Peripheral Parenteral Nutrition
    The British journal of surgery, 1996
    Co-Authors: J. May, John Macfie, D Palmer, P.m. Murchan, P. C. Sedman, R. Donat, C.j. Mitchell
    Abstract:

    Four techniques of administering Peripheral Parenteral Nutrition (PPN) were examined prospectively to investigate the role of mechanical trauma in the development of infusion phlebitis. Patients in group 1 (n = 15) were fed via a standard 18-G Teflon cannula which was removed on completion of the infusion and was rotated to the contralateral arm every day. Group 2 patients (n = 15) had a similar catheter sited in each forearm simultaneously, with rotation of the side of infusion each day. Patients in group 3 (n = 17) had a 15-cm Silastic rubber catheter inserted into a forearm vein and a standard cannula sited in the contralateral forearm, with alternation of infusion each day. Those in group 4 (n = 13) had a fine-bore 23-G silicone catheter sited in one arm only. Patients in groups 1, 2 and 3 were fed over 12-h cycles and those in group 4 for a 24-h continuous cycle. A total of 408 patient-days of PPN were given. Mean duration of PPN in groups 1-4 was 7.5, 9, 5.5 and 5 days respectively. Infusion phlebitis was not recorded in patients who had a daily change of cannula (group 1), but occurred in four patients in group 2, eight in group 3 and eight in group 4. Phlebitis scores were 0, 9, 15 and 12 for groups 1-4 respectively. Severe phlebitis and line occlusion occurred more frequently in patients with a 15-cm catheter (group 3) and in those fed continuously over 24 h (group 4). These results suggest that mechanical trauma is an important factor in the aetiology of infusion phlebitis. This can be minimized by reducing the time for which the vein wall is exposed to nutrient infusion and by reducing the amount of prosthetic material within the vein.

  • Administration of Peripheral Parenteral Nutrition: a prospective study comparing rotation of venous access sites with ultrafine cannulas.
    Clinical nutrition (Edinburgh Scotland), 1996
    Co-Authors: D Palmer, John Macfie, P.m. Murchan, I.m. Bradford, J.d. Harrison, C.j. Mitchell
    Abstract:

    Peripheral veins have been used successfully for patients requiring short- to medium-term total Parenteral Nutrition. This study prospectively compares two methods of Peripheral Parenteral Nutrition (PPN). Forty-six patients requiring Parenteral Nutrition (PN) were identified prospectively. Fifty courses of PPN were prescribed using a standardized PPN formula of 9.3 g nitrogen, 1400 kCal, 2500 ml (KABI II, Pharmacia). Patients were randomized to receive PPN via 23G, 15 cm flexane catheters (Nutriline) inserted into an antecubital vein which remained in-situ with a continuous infusion over 24 h, or to receive 12-h cyclical infusions through Peripherally sited 18G catheters (Venflon) which were removed postinfusion and reinserted into the contralateral forearm on alternate days. Data collected included duration, complications and cost of materials for each prescribed course. A scoring system to determine patient anxiety and depression and a questionnaire regarding patients' perspectives were evaluated. Fifty courses were prescribed, 26 by rotation of veins (RV) and 24 by Nutriline (N). Mean duration of feeding was 7.9 and 8.6 days, respectively; cost of materials were comparable 6.48/day (RV) vs 5.17/day (N); 2 RV patients failed to complete their course (no access [P< 0.05], whilst 9 N patients failed to complete their course (4 severe phlebitis, 2 no venous access, 2 septicaemia, 1 dislodged). Five patients required CPN (RV, N 3) while 4 remaining patients were fed by an alternative PPN method. The overall incidence of anxiety was 20% and of depression 16%, with no significant difference between groups. The majority of patients (87%) found mobility restricted. Twelve-hourly infusions via alternate forearm veins were significantly more successful than continuous infusions via Nutriline, both in terms of completion of the prescribed course and less venous morbidity. This study confirms that rotation of forearm veins allows affordable and successful PN administration to the majority of patients, with low PN-related morbidity.

Javier Gonzmel-gmiego - One of the best experts on this subject based on the ideXlab platform.

  • Antipyrine Clearance in Surgical Patients Maintained on Hypocaloric Peripheral Parenteral Nutrition
    2016
    Co-Authors: Javier Gonzmel-gmiego
    Abstract:

    ABSTRACT. Backgyound: Antipyrine clearance (CLAP) constitutes a sensitive indicator of hepatic microsomal enzyme activity providing specific information on hepatic function. The purpose of this study was to evaluate the influence of hypocaloric Peripheral Parenteral Nutrition on CLAP in patients receiving Nutrition support after elective surgery. Methods: CLAP was measured in 15 patients before elective gastrointestinal surgery and 6 days after the surgery. Antipyrine (1 g) was administered orally, and CLAP was determined by the one-sample method. Subjects received a postoperative 786 kcal/d regimen providing 66 g of amino acid per day and 133 g of glucose per day for 5 days. Nutritional status was evaluated by anthropometric parameters. A control group of 15 patients received no postoperative hypocaloric Peripheral Parenteral Nutrition but received conventional fluid therapy. Results: Mean CLAP wa

  • Antipyrine clearance in surgical patients maintained on hypocaloric Peripheral Parenteral Nutrition.
    JPEN. Journal of parenteral and enteral nutrition, 1994
    Co-Authors: Francisco Jorquera, Jesús M. Culebras, Mar Almar, Carlos Martinez, M. González-sastre, Javier Gonzmel-gmiego
    Abstract:

    Backgyound: Antipyrine clearance (CLAP) constitutes a sensitive indicator of hepatic microsomal enzyme activity providing specific information on hepatic function. The purpose of this study was to evaluate the influence of hypocaloric Peripheral Parenteral Nutrition on CL AP in patients receiving Nutrition support after elective surgery. Methods: CLAP was measured in 15 patients before elective gastrointestinal surgery and 6 days after the surgery. Antipyrine (1 g) was administered orally, and CLAP was determined by the one-sample method. Subjects received a postoperative 786 kcal/d regimen providing 66 g of amino acid per day and 133 g of glucose per day for 5 days. Nutritional status was evaluated by anthropometric parameters. A control group of 15 patients received no postoperative hypocaloric Peripheral Parenteral Nutrition but received conventional fluid therapy. Results: Mean CLAP was increased by 61% (0.66 ± 0.06 mL/min·kg-1 body wt vs 0.41 ± 0.05 mL/min·kg-1 body wt in the preoperative period; p

José Antonio Rodríguez-montes - One of the best experts on this subject based on the ideXlab platform.

  • Peripheral Parenteral Nutrition
    Revista de medicina de la Universidad de Navarra, 2006
    Co-Authors: Jesús M. Culebras, Gonzalo Martin-peña, A. García De Lorenzo, José Antonio Rodríguez-montes
    Abstract:

    The Target of this review is to provide an up-to-date overview of the advantages and disadvantages of Peripheral Parenteral Nutrition (PPN), including techniques, indications and results. The new generation catheters, together with a better knowledge of the intermediary metabolism, give us the opportunity to use PPN in many clinical situations for short periods of time. PPN is an alternative to Total Parenteral Nutrition (TPN) and is also a complement to enteral Nutrition and to the oral route. Progress in the design of catheters and their materials, in infusion techniques and better knowledge of optimal nutrients has made PPN into an effective, safe and useful therapy in the treatment of patients for certain periods of time.

  • Practical aspects of Peripheral Parenteral Nutrition.
    Current Opinion in Clinical Nutrition and Metabolic Care, 2004
    Co-Authors: Jesús M. Culebras, Gonzalo Martin-peña, Abelardo García-de-lorenzo, A. Zarazaga, José Antonio Rodríguez-montes
    Abstract:

    PURPOSE OF REVIEW: The purpose of this review is to provide an update on the advantages and disadvantages of using Peripheral Parenteral Nutrition, including the techniques, indications and results. RECENT FINDINGS: The new catheters, together with a better knowledge of intermediate metabolism, permit the use of Peripheral Parenteral Nutrition in many clinical situations during short periods of time. SUMMARY: Peripheral Parenteral Nutrition is an alternative to total Parenteral Nutrition, and is a complement to enteral Nutrition and the oral route. Progress in catheter design and materials, infusion techniques and an improved knowledge of the optimal nutriments has made Peripheral Parenteral Nutrition a safe, efficient and useful method to treat patients over certain periods of time.

  • Practical aspects of Peripheral Parenteral Nutrition.
    Current opinion in clinical nutrition and metabolic care, 2004
    Co-Authors: Jesús M. Culebras, Gonzalo Martin-peña, Abelardo García-de-lorenzo, A. Zarazaga, José Antonio Rodríguez-montes
    Abstract:

    Purpose of reviewThe purpose of this review is to provide an update on the advantages and disadvantages of using Peripheral Parenteral Nutrition, including the techniques, indications and results.Recent findingsThe new catheters, together with a better knowledge of intermediate metabolism, permit th