PARENTERAL NUTRITION AT HOME FOR 5-YEARS VIA ARTERIOVENOUS-FISTULAS - SUPPLEMENTAL INTRAVENOUS FEEDINGS FOR A PATIENT WITH SEVERE SHORT BOWEL SYNDROME

Abstract

On March 26, 1970, a 33 yr old male suffered intestinal infarction which required total enterectomy and duodeno-transverse colostomy. Nutrition was maintained in the hospital by daily parenteral feeding for 2 mo. postoperatively, after which parenteral feedings were decreased and stopped for long periods. Various oral dietary regimens failed to provide adequate nutrition, and the patient lost 40 kg and became severely malnourished during the next 13 mo. In June 1971, supplemental home parenteral nutrition (PN) via an arteriovenous fistula was instituted on a 3 or 4 nights per week basis. The patient''s weight and strength increased markedly after institution of the home supplemental PN program. The 1st fistula became occluded after 9.5 mo. of home PN use and subsequent successive fistulae remained patent for 31.3, 8.8 and 5.5 mo. of use. The patient prepares his own PN fluids at home, using a commercial device for filling plastic i.v. fluid bags. Although several different types of fluid were used, the current mixture of 25% glucose and 2.75% amino acids with added vitamins, K, Ca, Mg and insulin plus simultaneously administered lipid emulsion proved most effective. When the patient''s low fat, low oxalate diet was supplemented with this parenteral mixture 4 nights/wk he was in positive N, P and Mg balance. His negative Ca balance was only partially corrected. There was no sepsis, embolism or fistula infection during 5 yr of home PN.