Use of parenteral nutrition in the management of enterocutaneous fistula.

Nutrition plays an integral role in the management of patients with enterocutaneous fistula (ECF), but practice guidelines are often vague because of limited evidence. As a result, clinicians must rely on expert consensus and sound nutrition principles to guide practice. The initial phase of ECF management involves recognition (eg, fistula location and quantifying output) and stabilization (eg, source control and fluid and electrolyte balance).

Real-world experience with glucagon-like peptide 2 analogues in patients with short bowel syndrome and chronic intestinal failure: Results from an international survey in expert intestinal failure centers.

Background And Aims: Glucagon-like peptide 2 (GLP-2) analogues are the first available disease-modifying treatments for patients with intestinal failure (IF) due to short bowel syndrome (SBS). Efficacy in terms of reduction of parenteral support (PS) has been demonstrated in multiple studies and real-world reports. However, it remains unclear how many patients are eligible to receive the treatment, when treatment is started after intestinal resection, how treatment efficacy is assessed outside of clinical trials, and how the treatment is modified in case of non-response or adverse events.

Expert consensus statements and summary of proceedings from the International Safety and Quality of Parenteral Nutrition Summit.

Purpose: The International Safety and Quality of Parenteral Nutrition (PN) Summit consisted of presentations, discussions, and formulation of consensus statements. The purpose here is to briefly summarize the summit and to present the consensus statements.

Summary: There was a high degree of consensus, with all statements approved by all authors/summit experts.

Parenteral nutrition at home/long-term parenteral nutrition.

Purpose: Some diseases require that patients receive parenteral nutrition (PN) over a prolonged time period. Long-term administration of PN can further complicate an already complex therapy, posing additional risk of potential complications. This article is based on presentations and discussions held at the International Safety and Quality of PN Summit, providing insights into aspects of home PN (HPN) and examples of good HPN practice.

Significant Published Articles in 2022 for Pharmacy Nutrition Support Practice.

The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2022 considered important to their clinical practice. The citation list was compiled into a spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice.

Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey.

Background: International practice guidelines for high-stool-output (HSO) management in short bowel syndrome (SBS) are available, but data on implementation are lacking. This study describes the approach used to manage HSO in SBS patients across different global regions.

Methods: This is an international multicenter study evaluating medical management of HSO in SBS patients using a questionnaire survey.

Advocating for a patient- and family centered care approach to management of short bowel syndrome.

Patient- and family centered care (PFCC) is a model of providing healthcare that incorporates the preferences, needs, and values of the patient and their family and is built on a solid partnership between the healthcare team and patient/family. This partnership is critical in short bowel syndrome (SBS) management since the condition is rare, chronic, involves a heterogenous population, and calls for a personalized approach to care. Institutions can facilitate the practice of PFCC by supporting a teamwork approach to care, which, in the case of SBS, ideally involves a comprehensive intestinal rehabilitation program consisting of qualified healthcare practitioners who are supported with the necessary resources and budget.

Managing nutrition support product shortages: What have we learned?

Product shortages related to the components of parenteral nutrition (PN) therapy have been well described over the past decade. The situation has more recently worsened and expanded globally because of the impact the COVID-19 pandemic has placed on supply chain issues and workforce demand. The impact of enteral nutrition (EN) product shortages is less well documented when compared with PN, and development of management strategies is often left up to the discretion of individual providers.

Significant Published Articles in 2021 for Pharmacy Nutrition Support Practice.

The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2021 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice.

Significant Published Articles in 2020 for Pharmacy Nutrition Support Practice.

The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2020 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice.

Significant Published Articles for Pharmacy Nutrition Support Practice in 2019.

The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2019 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice.

[ASPEN-FELANPE Clinical Guidelines: Nutrition Support of Adult Patients with Enterocutaneous Fistula].

Background: the management of patients with enterocutaneous fistula (ECF) requires an interdisciplinary approach and poses a significant challenge to surgeons, gastroenterologists, intensivists, wound/stoma care specialists, and nutrition support clinicians. Available guidelines for optimizing nutritional status in these patients are often vague, based on limited and dated clinical studies, and typically rely on individual or institutional experience. Specific nutrient requirements, appropriate route of feeding, role of immune-enhancing nutrients, and use of somatostatin analogs in the management of patients with ECF remain a challenge for the clinician.

Significant Published Articles for Pharmacy Nutrition Support Practice in 2018.

The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2018 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice.

Challenges and Obstacles of Long-Term Home Parenteral Nutrition.

Patients receiving long-term home parenteral nutrition (HPN) and clinicians managing their care face complex challenges not fully addressed by existing clinical practice guidelines. This review aims to increase awareness of some of the challenges encountered when managing patients receiving HPN and provide strategies for management. The ability to optimally manage these patients starts with involvement of a qualified team of clinicians, which is sometimes difficult to find.

Significant Published Articles for Pharmacy Nutrition Support Practice in 2017.

The purpose of the article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2017 considered important to their clinical practice. The citation list was compiled into a spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice.

Parenteral Nutrition: Indications, Access, and Complications.

Parenteral nutrition (PN) is a life-sustaining therapy in patients with intestinal failure who are unable to tolerate enteral feedings. Patient selection should be based on a thorough assessment to identify those at high nutrition risk based on both disease severity and nutritional status. This article reviews both the acute and chronic indications for PN as well as special formulation consideration in specific disease states, vascular access, and complications of both short-term and long-term PN.

Significant Published Articles for Pharmacy Nutrition Support Practice in 2016.

To assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2016 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the paper was considered important to nutrition support pharmacy practice.

ASPEN-FELANPE Clinical Guidelines.

Background: The management of patients with enterocutaneous fistula (ECF) requires an interdisciplinary approach and poses a significant challenge to physicians, wound/stoma care specialists, dietitians, pharmacists, and other nutrition clinicians. Guidelines for optimizing nutrition status in these patients are often vague, based on limited and dated clinical studies, and typically rely on individual institutional or clinician experience. Specific nutrient requirements, appropriate route of feeding, role of immune-enhancing formulas, and use of somatostatin analogues in the management of patients with ECF are not well defined.

Significant Published Articles for Pharmacy Nutrition Support Practice in 2014 and 2015.

Purpose: To assist the pharmacy clinician engaged in nutrition support in staying current with the most pertinent literature.

Methods: Several experienced board-certified clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2014 and 2015 that they considered to be important to their practice. Only those articles available in print format were considered for potential inclusion.

Significant publications for pharmacy nutrition support practice in 2013.

Purpose: To assist the pharmacy clinician engaged in nutrition support in staying current with the most pertinent literature.

Methods: Several experienced board-certified clinical pharmacists in nutrition support compiled a list of publications published in 2013 that they considered to be important to their practice. The citation list was compiled into a Web-based survey whereby pharmacist members of the American Society for Parenteral and Enteral Nutrition (A.

A.S.P.E.N. clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling, and dispensing.

Background: Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation.

Pharmacologic management of diarrhea in patients with short bowel syndrome.

Diarrhea associated with short bowel syndrome (SBS) can have multiple etiologies, including accelerated intestinal transit, gastric acid hypersecretion, intestinal bacterial overgrowth, and malabsorption of fats and bile salts. As a result, patients may need multiple medications to effectively control fecal output. The armamentarium of antidiarrheal drugs includes antimotility agents, antisecretory drugs, antibiotics and probiotics, bile acid-binding resins, and pancreatic enzymes.

Home parenteral nutrition: safe transition from hospital to home.

Parenteral nutrition (PN) is a complex therapy that may result in serious harm if not properly prescribed, prepared, and administered. The patient who is discharged home on PN for the first time poses significant safety challenges and requires coordination of care between several healthcare disciplines within and outside the hospital. Use of an experienced prescriber and multidisciplinary team to oversee the home PN therapy is an important measure to optimize safety.