title: Team approach to long-term intravenous feeding in patients with gastrointestinal disorders.
abstract: A system has been developed for the prolonged administration of intravenous feeding in general wards. The service is coordinated by a clinician, specialist nurse, and pharmacist. Under local anaesthesia a silicone-rubber catheter is introduced through an infraclavicular incision to create a skin tunnel. By this technique 22 of 27 treatment periods (mean duration 42 days) required the use of only one catheter each. Ward care is simplified by the use of 3 litre bags containing aminoacids, glucose, electrolytes, and trace elements. The bags are prepared under laminar-flow conditions by a pharmacist in a specially designed room. Vitamins are added to the mixture and 'Intralipid" is infused separately as needed. In 38 treatment periods over a total of 1551 days weight-gain and gain in fat-free mass when required were satisfactory; the weight-gain correlated with increase in arm-muscle cross-sectional area (r = 0.72). Patients who have learnt to use the catheter have left the hospital for periods of up to 3 days, and 2 patients have given themselves intravenous supplements regularly at night in their homes.
mesh_terms: D000596:Amino Acids / Q000008:administration & dosage; D002404:Catheterization / Q000379:methods; D003093:Colitis, Ulcerative / Q000178:diet therapy; D003110:Colonic Neoplasms / Q000178:diet therapy; D003424:Crohn Disease / Q000178:diet therapy; D004573:Electrolytes / Q000008:administration & dosage; D005069:Evaluation Studies as Topic; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage; D005947:Glucose / Q000008:administration & dosage; D006757:Hospital Units / Q000458:organization & administration; D006801:Humans; D008131:London; D010288:Parenteral Nutrition / Q000379:methods*; D010348:Patient Care Team; D014131:Trace Elements / Q000008:administration & dosage; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D000596:Amino Acids; D004573:Electrolytes; D005217:Fat Emulsions, Intravenous; D014131:Trace Elements; D014815:Vitamins; D005947:Glucose