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More than 100 patient-years' experience has been acquired in the treatment of 133 patients with ambulatory home total parenteral nutrition (TPN) between May 1974 and December 1983. Indications for chronic or permanent home TPN include short bowel syndrome, malabsorption, scleroderma, and vasoactive intestinal polypeptide syndrome. Indications for acute or temporary home TPN include Crohn's disease, malignancies, gastrointestinal fistulas, ulcerative colitis, anorexia nervosa, and numerous other disorders. Eighty-two patients in the acute group were treated primarily with percutaneously placed standard subclavian catheters and 51 patients in the chronic group have been treated thus far with implanted silicone rubber, Dacron-cuffed catheters for a cumulative total of 38,939 patient days. Of the 125 implanted catheters, 115 were placed in the superior vena cava and ten in the inferior vena cava for an average duration of 250 catheter-days, the longest single catheter remaining in situ for more than 8 1/2 years. Catheter-related sepsis occurred 33 times with the implanted catheters, or once every 2.6 catheter-years. One hundred and fourteen temporary catheters were placed percutaneously in the superior vena cava via a subclavian vein for an average duration of 68 days, the longest single catheter remaining in situ for 213 days. Catheter-related sepsis occurred seven times, equivalent to one episode per 3 catheter-years. Total catheter-related complications were quite infrequent and were directly related to duration of catheterization. They included venous thrombosis (12), clotted catheter (11), catheter failure or rupture (8), catheter compression (5) and inadvertent catheter removal (4). Twenty-six catheters were repaired or spliced in situ when the external segment was accidentally damaged or deteriorated secondary to long-term material fatigue. One remarkable patient has been maintained exclusively by TPN originally as an inpatient and subsequently as an outpatient for the entire 13 years of his life.
S J Dudrick, and
J J O'Donnell, and
D M Englert, and
R G Matheny, and
E R Blume, and
R E Nutt, and
M S Hickey, and
A O Barroso
January 1987,
JPEN. Journal of parenteral and enteral nutrition,
S J Dudrick, and
J J O'Donnell, and
D M Englert, and
R G Matheny, and
E R Blume, and
R E Nutt, and
M S Hickey, and
A O Barroso
April 1981,
Gastroenterologie clinique et biologique,
S J Dudrick, and
J J O'Donnell, and
D M Englert, and
R G Matheny, and
E R Blume, and
R E Nutt, and
M S Hickey, and
A O Barroso
March 1984,
Minerva chirurgica,
S J Dudrick, and
J J O'Donnell, and
D M Englert, and
R G Matheny, and
E R Blume, and
R E Nutt, and
M S Hickey, and
A O Barroso
November 1984,
Caring : National Association for Home Care magazine,
S J Dudrick, and
J J O'Donnell, and
D M Englert, and
R G Matheny, and
E R Blume, and
R E Nutt, and
M S Hickey, and
A O Barroso
May 1988,
The British journal of surgery,
S J Dudrick, and
J J O'Donnell, and
D M Englert, and
R G Matheny, and
E R Blume, and
R E Nutt, and
M S Hickey, and
A O Barroso
June 1992,
Transplantation proceedings,
S J Dudrick, and
J J O'Donnell, and
D M Englert, and
R G Matheny, and
E R Blume, and
R E Nutt, and
M S Hickey, and
A O Barroso
January 1986,
Nursing times,
S J Dudrick, and
J J O'Donnell, and
D M Englert, and
R G Matheny, and
E R Blume, and
R E Nutt, and
M S Hickey, and
A O Barroso
November 1976,
Canadian journal of surgery. Journal canadien de chirurgie,
S J Dudrick, and
J J O'Donnell, and
D M Englert, and
R G Matheny, and
E R Blume, and
R E Nutt, and
M S Hickey, and
A O Barroso
January 1985,
NITA,
S J Dudrick, and
J J O'Donnell, and
D M Englert, and
R G Matheny, and
E R Blume, and
R E Nutt, and
M S Hickey, and
A O Barroso
September 1984,
AORN journal,
