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Lipid emulsions in lonf-term parenteral nutition
Ševela, Stanislav ; Novák, František (advisor) ; Cahová, Monika (referee) ; Lahoda Brodská, Helena (referee)
The combination of intestinal failure and parenteral nutrition is a condition associated with mild chronic inflammation and organ injury, the most significant of which is hepatic injury. This crossover-controlled trial investigated the effects of different intravenous lipid emulsions (IVLE) enriched with increased doses of omega-3 polyunsaturated fatty acids (n-3 PUFA) from fish oil (FO) in patients on home parenteral nutrition (HPNP) for chronic intestinal failure. Twelve patients were consecutively given three different IVLEs, with an FO emulsion added after each IVLE. The study also included twelve paired healthy controls for comparison. The aim of this study was to investigate how long-term administration of these IVLEs affected primarily the erythrocyte and plasma fatty acid (FA) spectrum, as well as the inflammatory response, antioxidant status, markers of liver function and bile acid spectrum in HPNP, and how these changes differed from healthy subjects. We demonstrated successful incorporation of n-3 PUFA into erythrocyte phospholipids and corresponding changes in the plasma FA spectrum, characterized in particular by significant increases in n-3 versus n-6 PUFA, with a decrease in the n-6/n-3 PUFA ratio. We also found a more prolonged effect on these changes with high dose FO...
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Quality of Patient Education in the Home Parenteral Nutrition Programme
Koťátková, Michaela ; Tomová, Šárka (advisor) ; Hromádková, Jaroslava (referee)
The bachelor thesis deals with the quality of education of clients who were included in the home parenteral nutrition program. The thesis is divided into the theoretical and empirical parts. Indications, contraindications, and history of home parenteral nutrition are described in theoretical part. Also, its division by types and the most often used vascular entrances. The characteristics of education in nursing, the educational process, its goals, evaluation, and method of creating documentation for the implementation of all phases of the educational process are also described. The method of the survey investigation is described in the empirical part. It was conducted by using of a quantitative method by distributing non-standardized questionnaires to clients who have already been educated or will be educated during the survey. The purpose of this thesis is to gain the knowledge about how clients perceive the way of education conducted at our workplace, what information they consider to be insufficient, missing, or incomprehensible, and on what information or educational materials they would still like to have. Based on the information obtained in this way, the comprehensive information brochure will be created, to serve clients a clear and understandable whole about home parenteral nutrition. And,...
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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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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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Mobile home parenteral nutrition
Votavová, Markéta ; Meisnerová, Eva (advisor) ; Čapková, Radka (referee)
A stationary or portable infusion pump can be used to administer home parenteral nutrition (HPN). The stationary pump (SP) must be fasten to the infusion stand, so patients administer infusions in night mode to maintain their quality of life and mobility in the daytime. However, administering the HPN at nighttime can cause complications. Conversely, the portable pump (PP) does not have to be fasten to the infusion stand and the infusions can be administered in day mode during activities, as the PP can be placed in a special backpack. The aim of this diploma thesis is to evaluate the administration of HPN in day mode in patients with a PP and further to evaluate and compare the results of quality of life and liver function tests results in patients with a PP and a SP. HPN patients with a PP and a SP completed the HPN-QOL questionnaire in the nutritional clinic at the 4th internal clinic of the General University Hospital in Prague during outpatient visits. In addition to that, patients with a PP completed a questionnaire focused on the administration of HPN in day mode. Liver function tests results (total bilirubin, ALT, AST, GGT, ALP, cholinesterase and albumin) were obtained from patients' medical records. A total of 14 respondents with a PP and 14 respondents with a SP were included in the...
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Home parenteral nutrition during a day and night regime
Fidlerová, Karolína ; Meisnerová, Eva (advisor) ; Staněk, Ivo (referee)
This diploma thesis deals with home parenteral nutrition in the day and night regime and its effect on patients. Parenteral nutrition is usually administered at night so that patients can do normal daily activities and so that nutrition administered in this way has the least impact on their lives. Parenteral nutrition is not a physiological route of nutrient administration and it is not natural for the human body to process nutrients at night. The first part of the theoretical work presents parenteral nutrition and its composition, indications, contraindications and complications. The next part of the thesis describes home parenteral nutrition and its organisation which is necessary for this form of nutritional support to be implemented. It is necessary to monitor many laboratory values on parenteral nutrition, the theoretical part specifically mentions cholesterol, triacylglycerols, glycemia or liver function tests. One of the important parts is the chapter about circadian rhythms, hormones and metabolic changes in energy intake at night. Qualitative research was chosen for this work, which involved 17 patients on home parenteral nutrition. These patients were getting their nutrition during the night. Their laboratory values such as liver function tests, glycaemia and blood fats was evaluated and...
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Indirect calorimetry in patients with home parenteral nutrition
Neradová, Andrea ; Meisnerová, Eva (advisor) ; Ševela, Stanislav (referee)
Introduction: Establishing the energy expenditure of patients with home parenteral nutrition (HPN) is a key component of nutritional care, just as important as being aware of how HPN affects energy expenditure. This helps prevent complications associated with excessive or insufficient nutrition. Certain studies have aimed at these issues have been carried out around the world, but little attention has been devoted to this subject in the Czech Republic as of yet. Several methods of ascertaining energy expenditure exist, with indirect calorimetry being considered the gold standard, however, in practice, various predictive equations are predominantly used instead. Aims: To compare the difference between the base metabolic rate (BMR) and the resting energy expenditure (REE) in patients with home parenteral nutrition. When measuring REE, to also establish the extent of the thermic effect of parenteral nutrition. Furthermore, to compare the results for energy expenditure (BMR, REE) obtained via indirect calorimetry with the results obtained via the frequently used predictive equations for calculating BMR and REE, and to ascertain which predictive equation most closely matched the measurements obtained via indirect calorimetry. Methodology: Outpatients with HPN seen at the 4th internal clinic of the...
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The influence of nursing procedures on the incidence of vascular access complications during home parenteral nutrition
Chalušová, Petra ; Meisnerová, Eva (advisor) ; Pražáková, Zuzana (referee)
(EN) Home parenteral nutrition (DPV) has become a routine part of patients care whose oral intake is reduced or completely eliminated. An integral part of the application of DPV is also the permanent or temporary need for functioning vascular access. Catheter complications negatively affect the quality of life, morbidity and in case of catheter sepsis the patient mortality. In addition it also brings increased costs for therapy and the need for patients re-hospitalization. The main objective of our study is to analyze catheter-related complications and to determine whether use of catheter plugs like TauroLock and TauroLock Hep and Tegaderm CHG antimicrobial dressing affect the incidence of catheter complications with DPV, and whether the incidence of complications is affected by a person who treated the catheter. The secondary objective is to characterize patients with served DPV and types of catheter used for this purpose.The method chosen is a retrospective observational cohort study. The study contains 52 patients with 72 catheters (39 Broviac, 18 PICC and 15 ports). The monitored number of catheter- days in total was 33,875. We conclude that the use TauroLock Hep is effective in the prevention of catheter complications and significantly reduces the overall incidence of all complications (p =...
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Quality of life at home parenteral nutriton
Hauerová, Nikola ; Meisnerová, Eva (advisor) ; Novák, František (referee)
Bachelor thesis deals with quality of the life at home parenteral nutrition. Theoretical part briefly describes nutritional support, malnutrition and compares artificial nutrition. Further is described knowledge related to parenteral nutrition, its indications, contraindications, methods of filling; complications associated with venous access and the administration of nutrition itself. Other chapters focus on the home parenteral nutrition and last part deals with the notion: quality of life. To meet the main purpose of the work four objectives were set. The first objective was to determine the life quality of the patients on HPN. The second objective was to determine how patients on HPN were satisfied with support of the nutritional clinic. The third objective was to assess the extent to which symptoms affect the quality of life patients on HPN. A fourth objective was focused on comparing the quality of the life patients on HPN with and without stoma. The research part is compiled from anonymous standardized questionnaire dealing with the evaluation of quality of the life from the perspective of the patients themselves. The outcome of this work is detailed overview of the quality of the life and alerts the neglected quality of the life patients on HPN. Keywords: artificial nutrition, malnutrition,...
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