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Long-term vascular access for home parenteral nutrition and their complications
Králová, Petra ; Novák, František (advisor) ; Hocková, Jana (referee)
Home parenteral nutrition is a treatment enabling the patients with intestinal failure to live their lifes in their home environment. The possibility to commence and practise home parenteral nutrition requires not only a medical and pharmaceutical team, but also paramedical staff, which plays a signifiant part mainly in education of the patient and his close relatives. The study's aim was to characterize the patients involved in the home parenteral nutrition programme (HPN) and catheters used for this purpose and as well to analyze complication rate of the long term catheters related to their use and subsequent care. Into the retrospective quantitative study were included patiens treated with home parenteral nutrition since january 2009 to september 2015 within one nutrition care center. Data collection was realized by research in medical documentation. Altogether 135 patients were included in the study (93 female and 42 male), who have hade 227 catheters inserted in total (114 portcatheters, 73 Broviac catheters and 40 PICC) with 86 187 catheter days. The most frequent basic disease was cancer (36%) and the most prevalent indication to HPN was a short bowel syndrome (50%). Overall complication rate was 2,12/1000 catheter days (1,62 catheter sepsis, identically local infections and thrombotic...
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Influence of supplementation with n-3 polyunsaturated fatty acids on inflammatory markers in patients on long-term parenteral nutrition
Svěchová, Hana ; Novák, František (advisor) ; Meisnerová, Eva (referee)
SMOFLipid® is a commonly used fat emulsion for parenteral nutrition. We investigated how enrichment of SMOFLipid® with n-3 polyunsaturated fatty acids (PUFA) in a form of second fat emulsion, Omegaven® , changes fatty acid composition of total plasma phospholipids and erythrocyte phospholipids, cytokine concentrations in serum and in supernatant from in vitro whole blood culture stimulated with lipopolasaccharide (LPS) and we evaluated also changes in oxido- reductive balance. Eight patients on long-term home parenteral nutrition recieved both emulsions, SMOFLipid® (6 weeks) and SMOFLipid® +Omegaven® (4 weeks), one by one. We observed no significant differences in common laboratory and clinical parameters between these two types of diet. Enrichment of SMOFLipid® with Omegaven® led to an increase in eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) in total plasma phospholipids and there was also an increse in proportion of EPA in erythrocyte phospholipids, while proportion of DHA remained unchanged. These changes were in both phospholipids of plasma and erythrocyte compensated for a decrease in proportion of linoleic and arachidonic acid (n-6 PUFA). There were elevated IL-6 and TNF-α serum concentrations in patients after both diets. There was a decrease in IL-6 production by 36% with SMOFLipid®...
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Quality of life of patients using home parenteral nutrition
HOLOUBKOVÁ, Martina
This diploma thesis deals with the issue of life quality of patients taking home parenteral nutrition. Its intention is to present the achieved life quality scores in the individual domains of physical and mental health in comparison with general population and to point out the differences in what dimensions the life quality of these patients is particularly affected. The theoretical section describes the present situation of the issue of home parenteral nutrition in the CR and the system of the care about the patients. The chapter about indications and contraindications to HPN is elaborated in more detail. The possibilities of the long-term vascular accesses, the care about them are also mentioned here, and particularly the role of a nurse in patient education in transferring parenteral nutrition to the domestic environment. The problems with long-term parenteral nutrition resulting from mechanic, metabolic and septic complications are also outlined. Parenteral nutrition failure is the most serious problem, which is why a chapter on small intestine transplantation as the last resort to save a patient with combined failure of intestine and nutrition is included. The second part of the theoretical section describes the life quality. I wanted to define the nature of this unambiguously graspable a term, determinants affecting life quality are also mentioned here. The possibilities of life quality measurement and assessment and particularly the follow-up use of the obtained data are mostly summarized here. Goals and hypotheses: Two goals were set to meet the main purpose of the thesis: Goal 1: To find whether the life quality of patients on HPN differs from that of the general public. Goal 2: To find the spheres in which the life quality of patients on HPN is mostly affected. A zero hypothesis was set to achieve the goals: Life quality of patients on HPN does not differ from that of the general public. There is no statistically significant difference between men and women. Eight alternative hypotheses to each life quality domain followed: H1: Patients on HPN show lower life quality score compared to the general public in the sphere of physical functions. H2: Patients on HPN show lower life quality score compared to the general public in the sphere of physical roles' limitation. H3: Patients on HPN show lower life quality score compared to the general public in the sphere of emotional roles' limitation. H4: Patients on HPN show lower life quality score compared to the general public in the sphere of emotional limitation of social functions. H5: Patients on HPN show lower life quality score compared to the general public in the sphere of pain. H6: Patients on HPN show lower life quality score compared to the general public in the sphere of general mental health. H7: Patients on HPN show lower life quality score compared to the general public in the sphere of vitality. H8: Patients on HPN show lower life quality score compared to the general public in the sphere of general health perception. A quantitative method of collected data analysis was applied to the research implementation. The research was based on the standardized questionnaire SF-36 supplemented with questions dealing with identification of respondents, time consumption of their treatment and their consequent satisfaction at the beginning. The questionnaire was distributed to patients using home parenteral nutrition in specialized nutrition centres of the Thomayer Faculty Hospital in Prague, Faculty hospitals in Brno and Hradec Králové and also by electronic means through the website of the citizen association Life without Intestine. The obtained data were statistically evaluated and processed into illustrative tables and graphs.Detailed mapping of the problems of life quality and highlighting of the neglected spheres of life quality of patients using HPN are the outputs of the thesis. The results will be presented to the members of the workgroup for HPN within their.
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