Ebook Nutrition support for the critically ill: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Nutrition support for the critically ill: Part 2
Ebook Nutrition support for the critically ill: Part 2
Chapter 7Access and Complications of Parenteral NutritionDustin R. NeelKeywords Parenteral nutrition • Venous anatomy • Peripheral venous catheter • M Ebook Nutrition support for the critically ill: Part 2Midline catheter • Central venous catheter • Peripherally inserted central catheter (PICC) • Tunneled central venous catheter • Implantable central venous poll • Thrombophlebitis • Catheter-related infections • Blood stream infections • Pneumothorax • Air embolism • Catheter malposition • Pinch-off Ebook Nutrition support for the critically ill: Part 2syndrome • Catheter occlusion • Catheter thrombosis • Hyperglycemia • Hypoglycemia • Hyperlipidemia • Essential fatty acid deficiency • Hepatic steatoEbook Nutrition support for the critically ill: Part 2
sis • Nephromegaly • Metabolic bone disease • Refeeding syndromeKey Points•Peripheral venous access is indicated for short-term parenteral nutrition iChapter 7Access and Complications of Parenteral NutritionDustin R. NeelKeywords Parenteral nutrition • Venous anatomy • Peripheral venous catheter • M Ebook Nutrition support for the critically ill: Part 2 parenteral nutrition is rarely necessary. The major complication of peripheral venous access is thrombophlebitis.•Non-tunneled central venous catheters are placed via the Seidinger technique. The majority of complications including pneumothorax, air embolism, and bleeding, occur during initial plac Ebook Nutrition support for the critically ill: Part 2ement. These catheters may be used for short-term parenteral nutrition therapy.•Peripherally inserted central catheters (PICCs) are indicated for inteEbook Nutrition support for the critically ill: Part 2
rmediate-term access. Compared to central venous catheters, they have a lower infection risk but a higher incidence of thrombophlebitis, but dislodgemChapter 7Access and Complications of Parenteral NutritionDustin R. NeelKeywords Parenteral nutrition • Venous anatomy • Peripheral venous catheter • M Ebook Nutrition support for the critically ill: Part 2f parenteral nutrition in those patients that require it for an extended period of time. Occlusion and thrombosis results from a fibrin sheath formation w hich is a long-term complication of all access lines.•Infection is the number one complication in central venous catheters, with a wide range of Ebook Nutrition support for the critically ill: Part 2presentations. Sepsis is associated with significant morbidity and mortality. The most commonly isolatedD R. Neel. MD(M)Surgical Intensive Care Unit.Ebook Nutrition support for the critically ill: Part 2
Department of Surgery.Truman Medical Center. Kansas City. MO. USA e-mail: dustin.neel@lincmcd.orgD.s. Seres, c.w. Van Way. Ill teds.). Nutrition SuppoChapter 7Access and Complications of Parenteral NutritionDustin R. NeelKeywords Parenteral nutrition • Venous anatomy • Peripheral venous catheter • M Ebook Nutrition support for the critically ill: Part 2anism is Staphylococcus epidermidis. Tunneled, cuffed central venous lines placed in the subclavian vein carry the lowest infection risk.• Hyperglycemia, hyperlipidemia, and refeeding syndrome are complications of parenteral nutrition associated with its internal composition.IntroductionNutrition su Ebook Nutrition support for the critically ill: Part 2pport has been a crucial component of medical practice for decades. While voluntary oral nutrition is the best route of nourishment delivery for mostEbook Nutrition support for the critically ill: Part 2
patients, and enteral nutrition is considered the best alternative, some patients ultimately require parenteral nutrition (PN) 111. Since the first laChapter 7Access and Complications of Parenteral NutritionDustin R. NeelKeywords Parenteral nutrition • Venous anatomy • Peripheral venous catheter • M Ebook Nutrition support for the critically ill: Part 2].The first patient received PN at home in 1968 [4. 5]. Home PN is used largely for short-bowel syndrome, high-output enterocutaneous fistulae. or severe chronic gastrointestinal dysfunction, and is used to treat both electrolyte abnormalities and to provide all required nutrients [6]. Over 40.000 p Ebook Nutrition support for the critically ill: Part 2atients require PN at home annually, and there are many others who require PN temporarily during a medical or surgical crisis [1.4, 7. 8]. Despite 45Ebook Nutrition support for the critically ill: Part 2
years of successful clinical use, PN has been called poison and condemned as being inferior IO enteral nutrition [9-12]. However, when making comparisChapter 7Access and Complications of Parenteral NutritionDustin R. NeelKeywords Parenteral nutrition • Venous anatomy • Peripheral venous catheter • M Ebook Nutrition support for the critically ill: Part 2d to treat patients who cannot sustain oral or enteral feeding [5. 12]. In fact, all humans start their life on parenteral nutrition and adapt to enteral nutrition after exiting the womb and entering the world 110]. In the words of Sir David Cuthbertson, a prominent biochemist and nutritionist. ‘Les Ebook Nutrition support for the critically ill: Part 2t we forget. 1 would remind you that we all owe our fetal life till parturition to the passage of the nutrients we require from the blood vessels of oEbook Nutrition support for the critically ill: Part 2
ur mothers into blood vessels as they transverse the chorionic villi in close relation" J13. 14].Parenteral Access and ComplicationsIn 1656. Sir ChrisChapter 7Access and Complications of Parenteral NutritionDustin R. NeelKeywords Parenteral nutrition • Venous anatomy • Peripheral venous catheter • M Ebook Nutrition support for the critically ill: Part 2hundred years later. Dudrick and Wilmore used vinyl catheters in six beagle puppies to show that PN could support growth and development 110], Today. PN is widely used, and we have a bewildering variety of catheters available [ 15]. Over 50% of hospitalized patients have either a peripheral or centr Ebook Nutrition support for the critically ill: Part 2al catheter, and over live million central venous catheters are inserted yearly 116. 17|. But despite all of the advances, vascular access still remaiEbook Nutrition support for the critically ill: Part 2
ns one of the most important and challenging components of PN.Vascular Anatomy and PhysiologyVenous return is the most important characteristic in choChapter 7Access and Complications of Parenteral NutritionDustin R. NeelKeywords Parenteral nutrition • Venous anatomy • Peripheral venous catheter • M Ebook Nutrition support for the critically ill: Part 2determining best access locations and safe practices.Veins have three layers: the tunica intima, tunica media, and tunica adventitia. The innermost layer is the tunica intima which is in direct contact with the venous flow via a nonthrombogenic smooth low-friction surface. The middle layer is the tu Ebook Nutrition support for the critically ill: Part 2nica media which contains connective tissue with7 Access and Complications of Parenteral Nutrition101Internal Jugular VeinBasilic VeinExternal Iliac VEbook Nutrition support for the critically ill: Part 2
einExternal Jugular VeinSubclavian VeinBrachiocephalic (innominant) VeinSuperior Vena CavaCephalic VeinChapter 7Access and Complications of Parenteral NutritionDustin R. NeelKeywords Parenteral nutrition • Venous anatomy • Peripheral venous catheter • MChapter 7Access and Complications of Parenteral NutritionDustin R. NeelKeywords Parenteral nutrition • Venous anatomy • Peripheral venous catheter • MGọi ngay
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