Parenteral Nutrition

Treatment of MVID

What is parenteral nutrition?

Parenteral nutrition is an artificial feeding technique that involves injecting the necessary nutrients into the body via the vein, using a catheter, a central line or a port-a-cath. It is used when oral and enteral feeding are no longer possible or insufficient.

This is an unnatural technique, since it does not use the digestive system, which is usually the vehicle for food, but the vascular system. It therefore concerns patients with a temporarily or permanently blocked digestive tract, or one that is in major dysfunction, as is the case with MVID.

What are the indications and objectives of parenteral nutrition?

This is indicated in cases of digestive system failure (intestinal obstruction, extensive intestinal resection, major intestinal distress due to infection or lack of blood supply, generalized peritonitis, "paralyzed" intestine). Artificial nutrition is chosen when the patient is undernourished or at risk of malnutrition.

The aim of this type of technique is to provide the patient with an optimal supply of energy, protein, water and trace elements to enable the various organs to function, as well as to recover muscle mass, fat mass and the various reserves previously lost.

How is parenteral nutrition performed?

Parenteral nutrition involves injecting nutrients directly into a vein. It therefore bypasses the digestive system. The injection is made via a catheter. This is a small plastic tube inserted into the vein, at the end of which the food can be injected. Small catheters can be inserted into the veins of the arm. They have the disadvantage of being limited in the quantity of feed that can be injected.

When we want to administer the entire supply to the patient, we use a larger catheter inserted into a larger vein in the neck area. This is called a central line. When feeding is prolonged for several weeks or even months, we can use "tunnelled" catheters under the skin, or implantable port-a-cath chambers also placed under the skin. These devices reduce the number of catheter replacements required, as well as the risk of catheter infection.

Administered feed can be prepared in advance in the form of industrially-produced pouches. They are easy to use, but have a fixed composition.

A la carte" feeding bags can be produced in hospital laboratories. The different "ingredients" they contain can then be precisely selected to optimize intake according to the type of patient.

Once selected, the feeding bag is infused through the catheter or implantable chamber using a pump that determines the rate of administration.

Infusions are carried out every day for several hours, or even 24 hours a day.

Parenteral nutrition is a treatment in its own right, requiring strict hygiene and total asepsis. It can be carried out at home by private nurses, or by the patient and/or his or her family, following training validated and monitored by the referring hospital and the homecare provider.

What are the potential complications of parenteral nutrition?

The placement of a catheter or port-a-cath is an invasive procedure, requiring pricking or incision close to organs other than the targeted vein. There is therefore a risk of complications such as arterial hemorrhage, pleural perforation or other rarer complications.

A blood clot may form in the punctured vein. This clot may block the passage of blood, or come unstuck.

When handling catheters, care must be taken to avoid contamination by bacteria. In some cases, despite the utmost care, the equipment may become infected, resulting in a purulent discharge from the puncture site, an abscess, or the passage of bacteria into the bloodstream, triggering a generalized reaction in the body, such as a rise in temperature. Sometimes the catheter has to be removed to solve the problem.

There are also complications due to the nutrients injected. Sugar can increase abnormally in the blood when too much is administered. Kidneys can suffer from excessive protein intake. The same is true of the liver when it comes to lipids (fats). The patient may also suffer from vitamin or trace element deficiencies when parenteral nutrition is inadequate.

Feeding a severely malnourished patient too quickly can also lead to complications such as heart rhythm disorders and neurological problems.

Parenteral nutrition is not without its complications, which is why it's important to be able to find alternative therapies to treat MVID.

Home parenteral nutrition and patient quality of life

As often as possible, once parenteral nutrition (PN) has been started in hospital, the patient, whether a child or an adult, is invited to return home. Therapeutic education must take place in the expert center, covering equipment management (expiry date), what to do in the event of an incident, and even training in care techniques for the patient, parents or relatives.

The patient is discharged home when all requirements have been met: stability of the patient's condition, logistics, training of the patient, family, caregiver or private nurse, written protocols, home hygiene conditions, organization of emergency hospitalization of the patient in the event of incidents.

Advances in equipment (miniaturized pumps, bag composition) have gradually made life safer for patients at home. There are now pumps that can be programmed to provide step-downs and delayed starts, as well as communicating pumps. The use of backpacks with or without wheels containing the pump and pouch makes it possible to move around outside the home.

All this equipment allows you to lead an almost normal life. Strict compliance with rules of asepsis, hygiene and protocol reduces complications and emergency hospitalization, and gives life at home a reasonable quality. With proper organization and equipment logistics, everyone can find their feet and feel at ease in daily life.

Despite all these developments and improvements, parenteral nutrition is an unnatural, artificial form of nutrition, and the central venous catheter is an invasive device that can cause complications for patients, both in terms of their health (infections, thrombosis, deficiencies, imapct on the kidney, liver, bones) and their quality of life (burdensome sterile care, daily logistics, limited activities, travel, etc.).

IMPORTANT NOTE

This information is intended to provide general information only and should not be relied upon as a basis for diagnosis or treatment of individual cases. It is very important to consult your doctor about your particular case.