Nourish Clinical Insights Blog

Central Venous Access Device Infections and Home Parenteral Nutrition

2012-01-21T12:25:00.000-07:00

Cober MP, Kovacevich DS, Teitelbaum DH. Ethanol-lock therapy for the preventionof central venous access device infections in pediatric patients with intestinalfailure. JPEN. 2011;35:67-73.

Central venous access device (CVAD)infections are a problem in the home parenteral nutrition (HPN) patient.These infections include skin site infections and bloodstream infections. Infact, CVAD infection is one of the most common and most devastatingcomplications of HPN. In this study, the Michigan group did a retrospectiveanalysis of the use of the ethanol-lock therapy (locking the solution in thecatheter between uses). The group used a 70% ethanol solution. The dwell timefor the ethanol solution was 2 hours at a minimum. Patients had the ethanol drawnfrom the catheter and discarded prior to infusion. Catheter infections were diagnosedbased on 2002 guidelines from the Centers for Disease Control and Prevention.Patients in the study were deemed at-risk (defined as having had 2 CVADsreplaced because of infections or 2 previous infections from their current CVAD,or having limited remaining CVAD access). Fifteen patients, with an average ageof 5.9 years, were followed over 16 months on average. Throughout the studyperiod, 73% of patients remained infection-free. There was a statisticallysignificant decrease in the number of BSIs (bloodstream infections) per 1,000catheter days (8.0 BSIs before the ethanol lock technique was implemented,versus 1.3 BSIs afterward [p<.001]). None of the catheters was removedbecause of BSI. Two of the patients developed a tunnel infection. The incidenceof CVAD repair for leakage or disruption was not significantly different thanthat noted before initiation of ethanol-lock therapy.

There has been some concern of catheter damage in CVADs composed ofpolyurethane and subjected to ethanol-lock or flush, although this has not beenconfirmed in clinical studies. Many interventions for CVAD infections have beenexamined over the years, including wound patches and biofilms (specializeddevices to attach to catheters to maintain sterility), patient education, andantibiotic “lock,” among others. This study provides an alternative, andapparently successful, intervention for prevention of catheter infections inat-risk patients.

Study Evaluates 203 Home Enteral Nutrition (HEN) Patients

2012-01-21T12:24:00.000-07:00

Klek S, Szybinski P, Sierzega M, et al. Commercial enteral formulas andnutrition support teams improve the outcome of home enteral tube feeding. JPEN. 2011;3:380-385. (The authors arefrom Krakow, Poland. Some of the authors are employed by Nutrimed MedicalCorporation.)

This was an interesting study evaluating 203 home enteral nutrition(HEN) patients. To start, the patients were fed homemade diets (pureed tablefoods) for tube feeding for 12 months, with oversight by the family only.Following use of the homemade diets, the patients used commercial enteral tubefeeding (ETF) for 12 months, with the guidance of a nutritional support team(NST). When the patients used the ETF with the guidance of an NST, as comparedto when they used a homemade tube feeding with no NST, they had significantlyreduced hospital admissions (0.21/year [p<.001] vs. 1.2/year), duration ofhospitalizations (3.83 days [p<.001] versus 20.84 days), and duration of ICUstay (0.50 days [p<.001] versus 2.35 days). Also, the cost ofhospitalization was significantly reduced in the commercial ETF group that wasfollowed by an NST. In addition, the incidence of pneumonia, respiratoryfailure, urinary tract infection, and anemia were significantly reduced in thecommercial ETF/NST oversight group (p<.05).

This study used the same patients for their own controls, thus creatinga very good comparison study. Often when evaluating the use of a medicalproduct, we look at the cost of the intervention only. In this case, the use ofcommercial tube feeding and NST guidance was most likely more costly initially thanpureed table foods and oversight only by the family. However, the use ofcommercial ETF and NST guidance led to significantly improved clinical outcomesand a significant reduction in the cost of hospitalization. This study showsthat tube feeding at home is not an intervention that should be viewed as“secondary” to the other therapies the patient may be receiving. Proper use ofHEN can significantly impact patient clinical outcomes.

Free Consumer Teleconference

2010-03-16T17:00:00.004-06:00

Small Steps to Big Steps - Enhancing the Patient Experience — Free Consumer Teleconference

On March 16, 2010 - Join other HPEN consumers for a free teleconference on how Coram is leveraging both technology and direct consumer feedback to enhance the patient experience. The call is March 16 at 7pm Eastern. Call in information is available on our consumer events page.

We have also included excerpts from recent calls in our free quarterly HPEN consumer magazine Celebrate Life. Archive copies can be found on WeNourish.com, or if you would like to receive a printed copy, you can subscribe to Celebrate Life online.

-Your Nourish Nutrition Support Team

Small Steps to Big Steps - Enjoying the Holidays

2009-11-06T09:20:00.004-07:00

On November 17, 2009 - Join other HPEN consumers for a free teleconference on making the most of the holiday season! Holidays can be particularly challenging for TPN and tube feeding consumers. Our guest speaker, Faye Clements, RN will speak on social and emotional coping skills for the holidays and be available to answer your questions.

The call is November 17 at 7pm Eastern. Call in information is available on our consumer events page.

We have also included excerpts from recent calls in our free quarterly HPEN consumer magazine Celebrate Life. Archive copies can be found on WeNourish.com, or if you would like to receive a printed copy, you can subscribe to Celebrate Life online.

-Your Nourish Nutrition Support Team

Oral Rehydration Discussion

2009-07-21T09:59:00.002-06:00

Don't miss our monthly consumer conference call today at 7pm Eastern - This evening's topic is Good Hydration Knows No Season - Facts and tips on staying hydrated through the summer and beyond. Our featured speakers are Ezra Steiger, MD from the Cleveland Clinic, and Carol Ireton-Jones, PhD, RD. Call in information is available at www.wenourish.com/consumers/events.aspx.

-Your Nourish Nutrition Support Team

Oley 2009

2009-07-03T09:01:00.005-06:00

The Nourish Nutrition Support team enjoyed seeing everyone at this year's Oley Conference in St. Pete's beach, Florida! The Oley Foundation is a tremendous resource for parenteral and enteral nutrition consumers and Coram was proud to continue our support as a Gold Medallion partner, to provide local infusion emergency services for conference attendees, and to offer key educational sessions throughout the conference. You can learn more about the Oley Foundation on our website, WeNourish.com, or by visiting Oley.org.

- Your Nourish Nutrition Support Team

Clinical Nutrition Week 2009 - A Success!

2009-02-05T09:52:00.006-07:00

We enjoyed seeing everyone in New Orleans at CNW09! We are proud to have been a sponsor of both the 2009 Conference the Research Workshop (Micronutrients in Parenteral Nutrition) this year. Many thanks to those of you who stopped by our booth, attended our clinical poster presentations (now posted online), or enjoyed one of our many roundtable discussions. The conference is a wonderful resource for anyone committed to patient safety and the continued study and advancement of nutrition support therapy - if you weren't able to attend this year's conference, we encourage you to attend CNW10!

-Your Nourish Nutrition Support Team

Clinical Nutrition Week

2009-01-13T13:48:00.005-07:00

If you are in New Orleans for ASPEN's upcoming Clinical Nutrition Week (Feb 1-4), please be sure to come by and visit us at booth #602. Many of our clinical nutrition staff members will be presenting clinical case studies and conducting round table discussions throughout the event. We've made last years' case studies available for download, and will post the new studies immediately after the conference. We look forward to seeing you there!

-Your Nourish Nutrition Support Team

Welcome to the new WeNourish blog!

2008-12-12T16:27:00.002-07:00

Welcome to the new WeNourish blog. The Nourish Nutrition Support Program team is dedicated to bringing the most current information and updates to you, whether you are a tube feeding or TPN nutrition consumer, a caregiver or a healthcare professional seeking to learn more about these nutrition therapies. Please visit us regularly, and be sure to look through the many online resources available through our website, www.WeNourish.com.

Happy Holidays. We look forward to a great 2009 with you!

-Your Nourish Nutrition Support Team