Technical hazards of using nutritive mixtures in bags for cyclical intravenous nutrition: comparison with standard intravenous nutrition in 48 gastroenterological patients.

摘要

Three methods for dispensing nutritional solutions are compared in 48 patients with gastrointestinal diseases on intravenous nutrition during 3582 days. The protocol for intravenous nutrition applied by the nursing team and the solutions used were the same in the three groups. In group A standard bottles were used, while in group B, 31PVC-disposable bags were used--with fat emulsion included (group B1) or with fat excluded (group B2). When fat was excluded from the bags it was infused separately from a bottle. The mixtures were made under laminar flow by the nursing team who applied a strict protocol which included bacteriological testing. The infection rate observed in the bags was 0.046%. The rate of septic complications was not significantly reduced in group B2 or B1 compared with group A; the type of container used was therefore unimportant and the key was the aseptic handling of the intravenous solutions. The rate of mechanical complications, mainly due to catheter obstruction, was higher (p less than 0.001) when fat was included in the bags--that is, in group B1--than in groups B2 and A. For 26 patients a cyclical regime of intermittent feeding was easier to manage when bags were used. In group B, this system replaced the continuous method n 75% of all therapeutic days without adverse effect; it improved compliance and allowed ambulatory treatment. The use of cyclical feeding with separate fat infusions has further reduced the hazards of intravenous nutrition and allowed the development of a programme that can be implemented at home.