https://espen.info/documents/ENOncology.pdf

ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology

En un debate multidisciplinar, y tras revisar la evidencia disponible asi como la experiencia de los expertos, la IV Mesa de Trabajo Baxter-SENPE establece las indicaciones y pautas de manejo de los micronutrientes (vitaminas hidrosolubles y liposolubles y oligoelementos o elementos traza) en la Nutricion Parenteral. Se concluye en la conveniencia del aporte diario de micronutrientes contemplandose diferentes posibilidades en lo que respecta a dosis por exceso y defecto, sistemas de administracion, interacciones, monitorizacion y coste-efectividad.

/pdf/efectos-de-la-suplementacion-con-glutamina-sobre-el-sistema-egn1h491un.pdf

Efectos de la suplementación con glutamina sobre el sistema antioxidante y la peroxidación lipídica en pacientes críticos con nutrición parenteral

Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings.

When Is Parenteral Nutrition Appropriate

Preventing parenteral nutrition liver disease

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Standard versus individualized parenteral nutrition.

In current medical practice, standardization of procedures has become a desirable objective. The Spanish Society of Parenteral and Enteral Nutrition (SENPE) has undertaken a considerable effort to create clinical practice guidelines or documents of consensus and quality gold standards in artificial nutrition. As a result the SENPE group of standardization has put together a document called "Consensus of Paediatric Parenteral Nutrition" supported by the Spanish Society of Gastroenterology, Hepatology and Nutrition (SEGHNP) and by the Spanish Society of Hospital Pharmacies (SEFH). This is a reduced version of our work. The complete version is available at www.nutricionhospitalaria.com and www.senpe.com. This document covers many aspects such as paediatric patient indications, vascular access, macro and micro nutrients needs; also preparation in special situations, components, forms of prescription, possibilities for standardization of the elaboration and prescription, elaboration, administration, monitoring, complications and side effects. Much research has been done, incorporating current publications, books and clinical practice guidelines such as those published by the American Society for Parenteral and Enteral Nutrition (ASPEN) and by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) in collaboration with the European Society for Clinical Nutrition and Metabolism (ESPEN).

http://scielo.isciii.es/pdf/nh/v22n6/original9.pdf

Documento de consenso SENPE/SEGHNP/SEFH sobre nutrición parenteral pediátrica

Encuesta sobre protocolos de elaboración de nutrición parenteral pediátrica y revisión de la idoneidad de sus componentes

Objective Some decades ago, several studies were published describing vitamins degradation in parenteral nutrition (PN) and their catalysis by oligoelements such as copper. Thus, the practice of administering oligoelements and vitamins every other day and adding them the same day of PN was implemented. Today, in many Spanish hospitals these recommendations are still being followed although currently different products, type of containers, and ways of administration are used. The purpose of this review is to determine whether combined administration of vitamins and oligoelements with PN is recommended and how many days they remain stable while refrigerated under the current conditions of preparation and administration of PN. Setting We have reviewed the articles on vitamins stability in PN published after 1990. Results The results are controversial with vitamin A, although "all-in-one" administration and photo-protection remarkably decrease its degradation and there seems to be no difference between adding the vitamin before its administration and doing so previously. Vitamin E is stable with photo-protection for 3-7 days under refrigeration plus one additional day at room temperature if multilayered bags are used. Thiamine is stable if bisulfites-free amino acids solutions are used. Conclusions We conclude that vitamins and oligoelements may be administered together and PN be prepared before use if "all-in-one" photo-protected multilayered bags and bisulfite-free amino acids solutions are used.

Vitamins stability in parenteral nutrition

Objective: To describe the administration of drugs
through nasogastric tubes by the nursing staff of a
tertiary hospital and to identify the most common administration
errors.
Methods: An observational study was carried out
between November of 2010 and March of 2011. The study
population was the nursing staff of the hospital. A questionnaire
was created asking about the daily practice of
drugs administration through the nasogastric tube; a
score was assigned to each question. A document on
correct administration techniques of drugs through the
nasogastric tube was elaborated, which served for the
comparison of the answers obtained.
Results: A total of 162 surveys were answered. Most of
the staff (44.5%) had a deficient knowledge on the proper
administration techniques. 69.7% of the staff stated to
have grinded some time a tablet with enteric coverage,
and 66.2% a tablet with modified release. A significant
lower number of perceived obstructions per month was
obtained in those nurses with higher degree of knowledge,
in those consulting the Pharmacy Department when they
had doubts, and in those never having grinded a tablet
with enteric coverage of modified release.
Conclusions: It is observed that the knowledge on
proper administration of drugs through the nasogastric
tube by the nursing staff is deficient; therefore, it would
be convenient to carry out specific training courses as
well as a closer collaboration between the Pharmacy
department and the Nursing units.

/pdf/evaluacion-de-las-practicas-de-administracion-de-farmacos-4iy5vvt2k1.pdf

Evaluación de las prácticas de administración de fármacos por sonda nasoentérica y enterostomía en pacientes hospitalizados

Resumen
El uso de la nutricion parenteral domiciliaria (NPD)
en pacientes con cancer avanzado sin tratamiento curativo
continua siendo objeto de controversia y conlleva
una considerable carga emocional. Sin embargo, este
grupo de pacientes constituye la primera indicacion de
NPD en muchos programas.
Objetivo: Presentar las caracteristicas de una serie de
pacientes incluidos en un programa de NPD en los ultimos
diez anos.
Metodo: Estudio retrospectivo de las historias clinicas
de los once pacientes que recibieron NPD en este periodo.
Se recogieron los datos demograficos, clinicos, complicaciones
y evolucion y se compararon con la del grupo
de pacientes con enfermedad benigna que recibieron
NPD en el mismo periodo. Para las comparaciones se
utilizo la t de Student y el test de la Chi-cuadrado cuando
estuvieron indicados. Se considero significacion estadistica
si p < 0,05.
Resultados: Once pacientes recibieron NPD, nueve a
causa de una obstruccion intestinal irresoluble y dos por
una fistula de alto debito. La edad media del inicio de la
NPD fue de 50,8 ± 12,7 anos frente a los 37,3 ± 17,2 en el
grupo con enfermedad benigna (p < 0,05). La duracion
media del NPD fue de 71,05 ± 217 dias en el primer grupo,
sensiblemente inferior al segundo (387,12 ± 995,85;
p < 0,05), con un rango entre 5 y 760 dias. Los pacientes
recibieron la infusion a traves de un reservorio subcutaneo
ya previamente implantado (n: 9) y en dos ocasiones,
de forma electiva, a traves de un cateter tunelizado.
La tasa de infeccion fue superior en el grupo con cancer
(0,34 episodios/paciente y 1.000 dias de NPD) que en el
grupo con enfermedad benigna (0,08 episodios; p <
0,05). Solo en uno de los pacientes se suspendio la NPD
antes de los 5 dias previos al fallecimiento, por deterioro
clinico. Dos pacientes precisaron ingreso por una complicacion
asociada a la tecnica. En los dos casos se trato
de una fungemia que obligo a la retirada del cateter. La
calidad de vida medida mediante una escala de actividad
fue similar al inicio de la NPD en ambos grupos.
Ninguno de los pacientes que fueron incluidos en el programa
continua vivo.
Conclusiones: la NPD ofrece al paciente con cancer
avanzado y grave disfuncion intestinal la posibilidad de
tratamiento en su domicilio, con un bajo indice de complicaciones.
Si consideramos la corta duracion media de
la NPD, la inclusion en el programa ha de valorarse de
forma individual y revisarse periodicamente.

/pdf/nutricion-parenteral-domiciliaria-en-pacientes-con-cancer-3c4ir8zcb4.pdf

P. Gomis Muñoz

Papers

Documento de consenso SENPE/SEGHNP/SEFH sobre nutrición parenteral pediátrica

Encuesta sobre protocolos de elaboración de nutrición parenteral pediátrica y revisión de la idoneidad de sus componentes

Vitamins stability in parenteral nutrition

Evaluación de las prácticas de administración de fármacos por sonda nasoentérica y enterostomía en pacientes hospitalizados

Nutrición parenteral domiciliaria en pacientes con cáncer avanzado: experiencia en un solo centro a lo largo de diez años