Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1984 Jun;199(6):770–781. doi: 10.1097/00000658-198406000-00016

100 patient-years of ambulatory home total parenteral nutrition.

S J Dudrick, J J O'Donnell, D M Englert, R G Matheny, E R Blume, R E Nutt, M S Hickey, A O Barroso
PMCID: PMC1353466  PMID: 6428331

Abstract

More than 100 patient-years' experience has been acquired in the treatment of 133 patients with ambulatory home total parenteral nutrition (TPN) between May 1974 and December 1983. Indications for chronic or permanent home TPN include short bowel syndrome, malabsorption, scleroderma, and vasoactive intestinal polypeptide syndrome. Indications for acute or temporary home TPN include Crohn's disease, malignancies, gastrointestinal fistulas, ulcerative colitis, anorexia nervosa, and numerous other disorders. Eighty-two patients in the acute group were treated primarily with percutaneously placed standard subclavian catheters and 51 patients in the chronic group have been treated thus far with implanted silicone rubber, Dacron-cuffed catheters for a cumulative total of 38,939 patient days. Of the 125 implanted catheters, 115 were placed in the superior vena cava and ten in the inferior vena cava for an average duration of 250 catheter-days, the longest single catheter remaining in situ for more than 8 1/2 years. Catheter-related sepsis occurred 33 times with the implanted catheters, or once every 2.6 catheter-years. One hundred and fourteen temporary catheters were placed percutaneously in the superior vena cava via a subclavian vein for an average duration of 68 days, the longest single catheter remaining in situ for 213 days. Catheter-related sepsis occurred seven times, equivalent to one episode per 3 catheter-years. Total catheter-related complications were quite infrequent and were directly related to duration of catheterization. They included venous thrombosis (12), clotted catheter (11), catheter failure or rupture (8), catheter compression (5) and inadvertent catheter removal (4). Twenty-six catheters were repaired or spliced in situ when the external segment was accidentally damaged or deteriorated secondary to long-term material fatigue. One remarkable patient has been maintained exclusively by TPN originally as an inpatient and subsequently as an outpatient for the entire 13 years of his life.

Full text

PDF
770

Images in this article

772Fig. 1.
on p.772
773Figs. 2A and B.
on p.773
776Figs. 3A-C.
on p.776

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allardyce D. B. Preoperative parenteral feeding in Crohn's disease: preoperatively, to induce remission, and at home. Am Surg. 1978 Aug;44(8):510–516. [PubMed] [Google Scholar]
  2. Broviac J. W., Cole J. J., Scribner B. H. A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet. 1973 Apr;136(4):602–606. [PubMed] [Google Scholar]
  3. Byrne W. J., Ament M. E., Burke M., Fonkalsrud E. Home parenteral nutrition. Surg Gynecol Obstet. 1979 Oct;149(4):593–599. [PubMed] [Google Scholar]
  4. Byrne W. J., Burke M., Fonkalsrud E. W., Ament M. E. Home parenteral nutrition: an alternative approach to the management of complicated gastrointestinal fistulas not responding to conventional medical or surgical therapy. JPEN J Parenter Enteral Nutr. 1979 Sep-Oct;3(5):355–359. doi: 10.1177/014860717900300507. [DOI] [PubMed] [Google Scholar]
  5. Dudrick S. J. A clinical review of nutritional support of the patient. Am J Clin Nutr. 1981 Jun;34(6 Suppl):1191–1198. doi: 10.1093/ajcn/34.6.1191. [DOI] [PubMed] [Google Scholar]
  6. Dudrick S. J., Englert D. M., MacFadyen B. V., Jr, Souchon E. A. A vest for ambulatory patients receiving hyperalimentation. Surg Gynecol Obstet. 1979 Apr;148(4):587–590. [PubMed] [Google Scholar]
  7. Dudrick S. J., Englert D. M., Van Buren C. T., Rowlands B. J., MacFadyen B. V. New concepts of ambulatory home hyperalimentation. JPEN J Parenter Enteral Nutr. 1979 Mar-Apr;3(2):72–76. doi: 10.1177/014860717900300208. [DOI] [PubMed] [Google Scholar]
  8. Dudrick S. J., Jackson D. The short bowel syndrome and total parenteral nutrition. Heart Lung. 1983 Mar;12(2):195–201. [PubMed] [Google Scholar]
  9. Dudrick S. J., MacFadyen B. V., Jr, Souchon E. A., Englert D. M., Copeland E. M., 3rd Parenteral nutrition techniques in cancer patients. Cancer Res. 1977 Jul;37(7 Pt 2):2440–2450. [PubMed] [Google Scholar]
  10. Dudrick S. J., O'Donnell J. J., Clague M. B. Nutritional rehabilitation of the cancer patient. Prog Clin Biol Res. 1983;132D:161–170. [PubMed] [Google Scholar]
  11. Fleming C. R., McGill D. B., Berkner S. Home parenteral nutrition as primary therapy in patients with extensive Crohn's disease of the small bowel and malnutrition. Gastroenterology. 1977 Nov;73(5):1077–1081. [PubMed] [Google Scholar]
  12. Gallagher J. J., Trowbridge P. Acute massive ischemic bowel injury: another application for home total parenteral nutrition and a reappraisal. Conn Med. 1982 Apr;46(4):177–179. [PubMed] [Google Scholar]
  13. Hickman R. O., Buckner C. D., Clift R. A., Sanders J. E., Stewart P., Thomas E. D. A modified right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet. 1979 Jun;148(6):871–875. [PubMed] [Google Scholar]
  14. Jeejeebhoy K. N., Langer B., Tsallas G., Chu R. C., Kuksis A., Anderson G. H. Total parenteral nutrition at home: studies in patients surviving 4 months to 5 years. Gastroenterology. 1976 Dec;71(6):943–953. [PubMed] [Google Scholar]
  15. Jeejeebhoy K. N., Rosenberg I. H. Panel report on nutritional support of patients with gastrointestinal diseases. Am J Clin Nutr. 1981 Jun;34(6 Suppl):1206–1212. doi: 10.1093/ajcn/34.6.1206. [DOI] [PubMed] [Google Scholar]
  16. Lansky D., Doerr H. O., Ivey M. Teaching home parenteral nutrition to patients with limited compliance skills. JPEN J Parenter Enteral Nutr. 1982 Mar-Apr;6(2):160–162. doi: 10.1177/0148607182006002160. [DOI] [PubMed] [Google Scholar]
  17. Lavery I. C., Steiger E., Fazio V. W. Home parenteral nutrition in management of patients with severe radiation enteritis. Dis Colon Rectum. 1980 Mar;23(2):91–93. doi: 10.1007/BF02587600. [DOI] [PubMed] [Google Scholar]
  18. Lees C. D., Steiger E., Hooley R. A., Montague N., Srp F., Gulledge A. D., Wateska L. P., Frame C. Home parenteral nutrition. Surg Clin North Am. 1981 Jun;61(3):621–633. doi: 10.1016/s0039-6109(16)42456-4. [DOI] [PubMed] [Google Scholar]
  19. Milewski P. J., Irving M. H. Parenteral nutrition in Crohn's disease. Dis Colon Rectum. 1980 Sep;23(6):395–400. doi: 10.1007/BF02586786. [DOI] [PubMed] [Google Scholar]
  20. Miller D. G., Ivey M. F. Use of home parenteral nutrition in 4 patients with "untreatable" malignancies. JPEN J Parenter Enteral Nutr. 1979 Nov-Dec;3(6):457–458. doi: 10.1177/014860717900300610. [DOI] [PubMed] [Google Scholar]
  21. Morris J. A., Jr, Selivanov V., Sheldon G. F. Nutritional management of patients with malabsorption syndrome. Clin Gastroenterol. 1983 May;12(2):463–474. [PubMed] [Google Scholar]
  22. O'Donnell J. J., Clague M. B., Dudrick S. J. Percutaneous insertion of a cuffed catheter with a long subcutaneous tunnel for intravenous hyperalimentation. South Med J. 1983 Nov;76(11):1344–1348. doi: 10.1097/00007611-198311000-00004. [DOI] [PubMed] [Google Scholar]
  23. Oakley J. R., Steiger E., Lavery I. C., Fazio V. W. Catastrophic enterocutaneous fistulae; the role of home hyperalimentation. Cleve Clin Q. 1979 Winter;46(4):133–136. doi: 10.3949/ccjm.46.4.133. [DOI] [PubMed] [Google Scholar]
  24. Pollack P. F., Kadden M., Byrne W. J., Fonkalsrud E. W., Ament M. E. 100 patient years' experience with the Broviac silastic catheter for central venous nutrition. JPEN J Parenter Enteral Nutr. 1981 Jan-Feb;5(1):32–36. doi: 10.1177/014860718100500132. [DOI] [PubMed] [Google Scholar]
  25. Rosenberg I. H. Nutritional support in inflammatory bowel disease. Gastroenterology. 1979 Aug;77(2):393–396. [PubMed] [Google Scholar]
  26. Schneider P. J., Mirtallo J. M. Home parenteral nutrition programs. JPEN J Parenter Enteral Nutr. 1981 Mar-Apr;5(2):157–160. doi: 10.1177/0148607181005002157. [DOI] [PubMed] [Google Scholar]
  27. Scribner B. H., Cole J. J. Evolution of the technique of home parenteral nutrition. JPEN J Parenter Enteral Nutr. 1979 Mar-Apr;3(2):58–61. doi: 10.1177/014860717900300205. [DOI] [PubMed] [Google Scholar]
  28. Sheldon G. F. Role of parenteral nutrition in patients with short bowel syndrome. Am J Med. 1979 Dec;67(6):1021–1029. doi: 10.1016/0002-9343(79)90644-2. [DOI] [PubMed] [Google Scholar]
  29. Solassol C., Joyeux H. A compact portable prosthesis for total parenteral nutrition (T.P.N.) : ambulatory parenteral feeding in the hospital and home. Acta Chir Scand Suppl. 1976;466:78–84. [PubMed] [Google Scholar]
  30. Steiger E., Srp F. Morbidity and mortality related to home parenteral nutrition in patients with gut failure. Am J Surg. 1983 Jan;145(1):102–105. doi: 10.1016/0002-9610(83)90174-5. [DOI] [PubMed] [Google Scholar]
  31. Stewart G. R. Home parenteral nutrition for chronic short bowel syndrome. Med J Aust. 1979 Sep 22;2(6):317–319. [PubMed] [Google Scholar]
  32. Weiss S. M., Worthington P. H., Prioleau M., Rosato F. E. Home total parenteral nutrition in cancer patients. Cancer. 1982 Sep 15;50(6):1210–1213. doi: 10.1002/1097-0142(19820915)50:6<1210::aid-cncr2820500632>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES