Treatment of intestinal failure by total parenteral nutrition at home in children and adults
Naber, A.H.J.; Rings, E.H.H.M.; George, E.; Tolboom, J.J.M.; Jonkers, C.; Sauerwein, H.P.
Nederlands Tijdschrift Voor Geneeskunde 149(8): 385-390
2005
ISSN/ISBN: 0028-2162 PMID: 15751316 Document Number: 586722
Intestinal failure is characterized by the inability of the intestine to absorb sufficient nutrients to maintain the integrity and function of the body. This can be caused by malabsorption due to a very short intestine, by mucosal abnormalities, or by a severe motility disorder. In addition to dietary measures, the prescription of total parental nutrition (TPN) at home is sometimes necessary. This treatment is a burden on the patient and the risk of complications must be reduced to a minimum. The risks of long-term TPN can be limited and the quality of the provision of services can be increased if the coordination is in the hands of a centre for home TPN. In the Netherlands, there are two centres for home-TPN: the St Radboud University Medical Centre in Nijmegen and the University Medical Centre (AMC) in Amsterdam. In both children and adults, the most common indications are the short bowel syndrome and motility disorders. However, the syndromes that cause these are clearly different in the different age groups. TPN can be given for long periods of time. A large variety of complications can occur, related especially to the equipment or the nutrients. When the nutrition is given via a central venous catheter, then sepsis is a serious and possibly life-threatening complication. In case of administration via an arteriovenous shunt, thrombosis of the shunt is the most frequent problem. If the treatment by means of home-TPN fails, then transplantation of the small intestine should be considered.