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BACKGROUND: Nutrition nurses work in multidisciplinary and nurse-led outpatient clinics. The daily nutrition nurse-led 'hot' clinic in this study sees patients for enteral or home parenteral nutritional support. Appointments may be for routine procedures or emergency reviews. AIMS: This study aimed to identify activities and procedures performed in the nutrition nurse-led clinic, identifying admission avoidance activity. METHODS: Nurse-held records for the period from April 2018 to March 2020 were reviewed retrospectively. Data were collated in an Excel spreadsheet for analysis and results are presented using descriptive statistics. RESULTS: Records covered a total of 590 patients, 294 men and 296 women with a median age of 59 years, and 606 procedures. Key activities were troubleshooting enteral feeding tubes (29%), insertion of fine-bore nasogastric feeding tubes (18%) and management of home parenteral nutrition issues (11%). The presenting problem or issue was resolved in 90% of patients, with no need for hospital admission or additional medical review. CONCLUSION: The nutrition nurse-led clinic provides an efficient and cost-effective service, preventing hospital admission and emergency department attendance in most cases.
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Gastrostomía , Rol de la Enfermera , Masculino , Humanos , Femenino , Persona de Mediana Edad , Gastrostomía/métodos , Estudios Retrospectivos , Análisis Costo-Beneficio , Pacientes Ambulatorios , Intubación Gastrointestinal/métodos , Instituciones de Atención AmbulatoriaRESUMEN
INTRODUCTION: Patients with chronic intestinal failure (IF) require home parenteral nutrition (HPN). Central venous access is needed for prolonged use of PN, usually via a long term central venous access device (CVAD). Post insertion there may be mechanical complications with a CVAD such as catheter rupture or tear. Repair of damaged CVADs is possible to avoid risks associated with catheter replacement in patients with IF. However, catheter related blood stream infections (CRBSI) are a concern when CVAD's are accessed or manipulated. AIMS: To investigate the success of repair of CVADs in patients with IF on HPN, related to repair longevity and incidence of CRBSI following repair. METHOD: Nutrition team records of CVAD repairs carried out in patients with IF were reviewed retrospectively for the period April 2015 to March 2019. RESULTS: Nutrition Clinical Nurse Specialists carried out 38 repairs in 27 patients. Male n = 5, female n = 22; mean age 55 years. Catheter longevity before first repair (n = 27): median 851 days, IQR 137-1484 days. 30/38 (78.9%) of repairs were successful lasting ≥30days. Hospital admission was avoided in 76% of cases. 4 patients in the failed repair group underwent catheter re-insertion where 4 had a further, subsequently successful, repair, an overall success rate of 89.4% (34/38). 30-day CRBSI rate was 0.09/1000 catheter days in repaired catheters. In comparing costs, there is a potential cost saving of 2766GBP for repair compared to replacement of damaged CVADs. CONCLUSION: Repair of tunnelled CVADs in patients with IF is successful and safe with no increased risk of CRBSI. Significant cost savings may be made.
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Obstrucción del Catéter/estadística & datos numéricos , Cateterismo Venoso Central/instrumentación , Catéteres Venosos Centrales/efectos adversos , Insuficiencia Intestinal/terapia , Nutrición Parenteral en el Domicilio/instrumentación , Obstrucción del Catéter/efectos adversos , Obstrucción del Catéter/economía , Infecciones Relacionadas con Catéteres/economía , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/etiología , Cateterismo Venoso Central/economía , Catéteres Venosos Centrales/economía , Análisis Costo-Beneficio , Femenino , Humanos , Insuficiencia Intestinal/economía , Masculino , Persona de Mediana Edad , Enfermeras Clínicas/estadística & datos numéricos , Nutrición Parenteral en el Domicilio/economía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Difficulty with maintaining nutritional intake is common in patients with cancer. European guidance suggests that wherever possible nutritional support should first be provided by the oral or enteral route. Where this is not possible, for example, in malignant small bowel obstruction, parenteral nutrition (PN) may be considered. In palliative care, it is generally accepted that the significant risks and burdens of PN outweigh the potential benefits in patients with an expected survival <2 months. Determining prognosis is crucial when helping patients to make decisions regarding appropriate care pathways; however, this remains challenging. An overview of clinical issues and prognostic indicators related to selecting patients appropriately for palliative PN is given to cover the relevant advanced competencies of the 2010 Gastroenterology Curriculum. The organisation of Home Parenteral Nutrition (HPN) services in England is described including the associated risks and burdens of HPN in the palliative patient.
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Malnutrition is a clinical and public health problem. It has adverse effects on the physical and psycho-social wellbeing of individuals by predisposing to disease, negatively affecting its outcome and reducing the likelihood of independence. An estimated 3 million people in the UK are affected by malnutrition, most of whom live in the community ( BAPEN, 2011 ). Despite the scale of this problem, it remains under-detected, under-treated, underresourced and often overlooked by those involved in the care of at risks individuals such as the elderly. In most cases malnutrition is a treatable condition that can be managed by optimising food intake and using oral nutritional supplements (ONS) where necessary. The main focus of this article is on the dangers of malnutrition for older people in the community and the use of ONS in the treatment and management of malnutrition.