ENTERAL PARENTERAL BESLENME PDF

Parenteral nutrition PN is the feeding of specialist nutritional products to a person intravenously , bypassing the usual process of eating and digestion. The products are made by specialist pharmaceutical compounding companies and are considered to be the highest risk pharmaceutical preparations available as the products cannot undergo any form of terminal sterilization. The person receives highly complex nutritional formulae that contain nutrients such as glucose , salts , amino acids , lipids and added vitamins and dietary minerals. It is called total parenteral nutrition TPN or total nutrient admixture TNA when no significant nutrition is obtained by other routes, and partial parenteral nutrition PPN when nutrition is also partially enteric. It may be called peripheral parenteral nutrition PPN when administered through vein access in a limb rather than through a central vein as central venous nutrition CVN. Total parenteral nutrition TPN is provided when the gastrointestinal tract is nonfunctional because of an interruption in its continuity it is blocked, or has a leak — a fistula or because its absorptive capacity is impaired.

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Background: This is an update of the review last published in It focuses on early postoperative enteral nutrition after lower gastrointestinal surgery. Traditional management consisted of 'nil by mouth', where patients receive fluids followed by solids after bowel function has returned.

Although several trials have reported lower incidence of infectious complications and faster wound healing upon early feeding, other trials have shown no effect.

The immediate advantage of energy intake carbohydrates, protein or fat could enhance recovery with fewer complications, and this warrants a systematic evaluation. Objectives: To evaluate whether early commencement of postoperative enteral nutrition within 24 hours , oral intake and any kind of tube feeding gastric, duodenal or jejunal , compared with traditional management delayed nutritional supply is associated with a shorter length of hospital stay LoS , fewer complications, mortality and adverse events in patients undergoing lower gastrointestinal surgery distal to the ligament of Treitz.

We also searched for ongoing trials in ClinicalTrials. We handsearched reference lists of identified studies and previous systematic reviews. Selection criteria: We included randomised controlled trials RCT comparing early commencement of enteral nutrition within 24 hours with no feeding in adult participants undergoing lower gastrointestinal surgery.

Data collection and analysis: Two review authors independently assessed study quality using the Cochrane 'Risk of bias' tool tailored to this review and extracted data.

Data analyses were conducted according to the Cochrane recommendations. Primary outcomes were LoS and postoperative complications wound infections, intraabdominal abscesses, anastomotic dehiscence, pneumonia.

Secondary outcomes were: mortality, adverse events nausea, vomiting , and quality of life QoL. For analysis, we used an inverse-variance random-effects model for the primary outcome LoS and Mantel-Haenszel random-effects models for the secondary outcomes.

Main results: We identified 17 RCTs with participants undergoing lower gastrointestinal surgery. Most studies were at high or unclear risk of bias in two or more domains. Six studies were judged as having low risk of selection bias for random sequence generation and insufficient details were provided for judgement on allocation concealment in all 17 studies.

With regards to performance and deception bias; 14 studies reported no attempt to blind participants and blinding of personnel was not discussed either. Only one study was judged as low risk of bias for blinding of outcome assessor. For selective reporting, nine studies were judged as unclear as protocols were not provided and eight studies had issues with either missing data or incomplete reporting of results.

LOS was reported in 16 studies participants. The mean LoS ranged from four days to 16 days in the early feeding groups and from 6. Mean difference MD in LoS was 1. These results were confirmed by the TSA showing that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit.

We found no differences in the incidence of postoperative complications: wound infection 12 studies, participants, RR 0. The most commonly reported cause of death was anastomotic leakage, sepsis and acute myocardial infarction. Seven studies participants reported vomiting RR 1.

Four studies reported combined nausea and vomiting RR 0. Authors' conclusions: This review suggests that early enteral feeding may lead to a reduced postoperative LoS, however cautious interpretation must be taken due to substantial heterogeneity and low-quality evidence. For all other outcomes postoperative complications, mortality, adverse events, and QoL the findings are inconclusive, and further trials are justified to enhance the understanding of early feeding for these.

In this updated review, only a few additional studies have been included, and these were small and of poor quality. To improve the evidence, future trials should address quality issues and focus on clearly defining and measuring postoperative complications to allow for better comparison between studies. However due to the introduction of fast track protocols which already include an early feeding component, future trials may be challenging.

A more feasible trial may be to investigate the effect of differing postoperative energy intake regimens on relevant outcomes. All authors: none known.

Funnel plot of comparison: 1 Early enteral nutrition versus later commencement after gastrointestinal…. Trial sequential analysis of early enteral nutrition versus later commencement after gastrointestinal surgery,…. Comparison: 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome: 3…. Comparison: 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome: 4….

Comparison: 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome: 5…. Comparison: 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome: 6…. Comparison: 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome: 7….

Comparison 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome 1…. Comparison 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome 2…. Comparison 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome 3….

Comparison 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome 4…. Comparison 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome 5…. Comparison 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome 6…. Comparison 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome 7…. Comparison 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome 8….

Comparison 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome 9…. Comparison 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, Outcome 10….

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Update in Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Herbert G, et al. Cochrane Database Syst Rev.

PMID: Abstract Background: This is an update of the review last published in Conflict of interest statement All authors: none known. Figures Figure 1 5 Study flow diagram. Figure 1 13 Study flow diagram. Figure 2 5 'Risk of bias' graph: review….

Figure 2 13 'Risk of bias' graph: review authors' judgements about each risk of bias item…. Figure 3 5 'Risk of bias' summary: review…. Figure 3 13 'Risk of bias' summary: review authors' judgements about each risk of bias item…. Figure 4 5 Funnel plot of comparison: 1…. Figure 4 13 Funnel plot of comparison: 1 Early enteral nutrition versus later commencement after gastrointestinal…. Funnel plot of comparison: 1 Early enteral nutrition versus later commencement after gastrointestinal surgery, outcome: 1.

Figure 5 5 Trial sequential analysis of early…. Figure 5 13 Trial sequential analysis of early enteral nutrition versus later commencement after gastrointestinal surgery,…. Trial sequential analysis of early enteral nutrition versus later commencement after gastrointestinal surgery, outcome: 1.

Figure 6 5 Comparison: 1 Early enteral nutrition….

DUNGEONEER TOMB OF THE LICH LORD RULES PDF

Parenteral nutrition

Objective: This research was conducted in order to evaluate the knowledge level about parenteral and enteral nutrition practices of nurses and determine the associated factors with the knowledge. Method: It is a descriptive and cross-sectional study. The study was carried out at two hospitals. The sample was composed of nurses. Nurses' knowledge levels of enteral and parenteral nutrition practices were assessed using Knowledge Questionnaire for Parenteral Nutrition Practices and Knowledge Questionnaire for Enteral Nutrition Practices. Results: Mean age of sample was

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Year , Volume 16 , Issue 2, Pages - Zotero Mendeley EndNote. Abstract en tr Enteral Nutrition: current approaches in the care The most common complications developed in patients with enteral nutrition by nasogastric or nasoenteric are gastrointestinal, mechanical and metabolic. These complications can be simple or can reach life-threatening levels. It may cause under-nutrition of patients, diverse effects on healing process and prolonged hospitalization. Success of nutrition and reduction in complication rate can be obtained by patient care approaches in accordance with evidence-based guidelines and recommendations.

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