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Biomedical subjects

T O Lipman

Publications and source records attributed to T O Lipman.

31 records · Page 2Linked to original sources
PubMedDate not supplied

Bacterial safety of reconstituted continuous drip tube feeding.

Chemically defined diets require reconstitution and transfer to a delivery system. When reconstituted High Vivonex was noted in our Medical Center to be bacteriologically contaminated, we instituted a series of control procedures. We then reevaluated bacterial growth in reconstituted High Nitrogen Vivonex and diluted Isocal under ward conditions. The mixtures were prepared with sterile water versus tap water, using a hand washed blender versus a machine washed blender. We also investigated the bacteriological effect of blast freezing reconstituted High Nitrogen Vivonex. All preparations of the nonfrozen High Nitrogen Vivonex showed occasional low level contamination, although quantitative cultures did not show logarithmic growth over eight hours of observation. No growth occurred in the blast frozen High Nitrogen Vivonex or in the Isocal. We conclude that reconstituted High Nitrogen Vivonex and diluted Isocal may be prepared and hung safely for eight hours, and that blast freezing of High Nitrogen Vivonex is bacteriologically safe. As a result of our initial findings of bacteriologic contamination, we believe a program for bacterial monitoring of the tube feeding is desirable.

Bacterial Infections↗
PubMedDate not supplied

Parenteral nutrition and nutritional support in Veterans Administration Medical Centers.

Two surveys eliciting information regarding parenteral nutrition and nutritional support in Veterans Administration Medical Centers were performed in 1981. Of 133 answering Veterans Administration Medical Centers, 45% had nutritional support teams. Two-thirds of these nutritional support groups were reported to be active. If an attempt to assess the quality of these programs is made by establishing performance criteria, then 23 medical centers have active and well-functioning nutritional support programs.

Hospitals, Veterans↗
PubMedDate not supplied

Nasopulmonary intubation with feeding tubes: case reports and review of the literature.

Pulmonary aspiration of regurgitated feeding material is a recognized complication of enteral nutrition by feeding tube. Nasopulmonary intubation with feeding tubes has been reported infrequently. We present two patients with such complications. In one, nasopulmonary intubation resulted in a pneumothorax. In the other unrecognized misplacement resulted in pneumonia and hydrothorax. Similar cases in the literature are discussed. Common features of this complication are: (1) patients who are obtunded, debilitated, or without gag reflex; (2) previous successful insertion of a tube; (3) successful passage past endotracheal tubes and tracheostomies; and (4) positive auscultation of insufflated air over the left upper quadrant. Complete prevention of this complication probably is not possible, but health care personnel should be aware of this potential problem in the patient at risk.

Aged↗
PubMedDate not supplied

Central venous catheter care in parenteral nutrition: a review.

Central venous catheter care in parenteral nutrition has been described in numerous publications. These descriptions include care of both short- and long-term catheters. Important aspects in the prevention of infection in central venous catheters used for parenteral nutrition have included: the method of central venous access, subcutaneous tunneling, dressing change techniques, therapeutic uses of the catheter, and catheter-intravenous tubing connection care. Methods of predicting infection and evaluating catheter sepsis have been described. The efficacy of intervention by specialized nutrition support teams in infection control related to these catheters has been demonstrated. Newer partially implantable and completely implantable venous access devices have been used for parenteral nutrition. Methods of infection control and prevention of mechanical damage of these types of catheters have been examined with various results. Care and composition of central venous catheters have been shown to have some role in thrombus formation in the central veins. The use of heparin to prevent thrombosis and catheter occlusion, and the varying degrees of success obtained, have been described. Medical treatment of the occluded catheter with urokinase may be a necessary alternative to discontinuance of that catheter. Overall consideration of research methods used to reach conclusions for catheter care should be considered in the evaluation of appropriate care in each situation.

Catheters, Indwelling↗
PubMedDate not supplied

Vitamin prescriptions on a hospital general medical ward: result of a drug utilization review.

Records of 103 consecutive admissions to a general medical ward over 4 months in a Veterans Administration Medical Center were reviewed. Assessment was made of nutritional status and potential need for supplemental vitamin therapy based upon predetermined criteria. Thirty-five of the 103 patients received one or more vitamin supplements. No patient received unnecessary vitamins as defined by our criteria. However, 48 patients had indications for vitamin supplementation, but did not receive any. Analysis of data by indication for vitamin therapy revealed 125 indications for vitamin therapy in 83 patients. Of the 125 indications 54 were treated appropriately, but there were no vitamin prescriptions in 71 indicated instances. We conclude that indicated vitamin supplementation may be underutilized in hospitalized general medical patients.

Adult↗
PubMedDate not supplied

Bacterial translocation and enteral nutrition in humans: an outsider looks in.

PURPOSE: To assess the literature documenting the existence of bacterial translocation in humans, the effects of enteral nutrition on bacterial translocation in humans, and the hypothesis that enteral nutrition prevents bacterial translocation in humans. DATA IDENTIFICATION: Sources included Medline search, references from review articles, and references from animal and human studies. STUDY SELECTION: The goal was to include all animal and human studies directly addressing questions of bacterial translocation and nutritional status or nutritional support. DATA EXTRACTION: An attempt was made to briefly summarize methodology and findings of relevent studies. No general attempt was made to assess quality of individual studies. RESULTS OF DATA SYNTHESIS: Bacterial translocation is a well documented phenomenon in animal models. Starvation and malnutrition of themselves do not induce bacterial translocation, but may facilitate translocation in the presence of other systemic insults. Parenteral nutrition and many forms of enteral nutrition may induce and/or facilitate bacterial translocation. Chow and certain fiber sources seem protective. Moderate direct and several lines of indirect evidence support the existence of bacterial translocation in humans. There is no direct evidence and questionable indirect evidence suggesting that enteral nutrition prevents or modifies bacterial translocation in humans. CONCLUSIONS: The hypothesis relating enteral nutrition and bacterial translocation in critically ill patients remains attractive, but unproven.

Animals↗
PubMedDate not supplied

Grains or veins: is enteral nutrition really better than parenteral nutrition? A look at the evidence.

BACKGROUND: Enteral nutrition is said to be better than parenteral nutrition for providing nutrition support to humans. PURPOSE: To assess the literature documenting the assertions that enteral nutrition is superior to parenteral nutrition with respect to cost, safety, physiology, intestinal structure and function, bacterial translocation, and outcome. DATA IDENTIFICATION: Sources included MEDLINE search, personal files, and references from human comparative studies of enteral vs parenteral nutrition. STUDY SELECTION: The goal was to include all human studies directly addressing questions of comparative efficacy of enteral and parenteral nutrition. Emphasis was given to prospective randomized controlled studies where available. Retrospective comparisons were not included. DATA EXTRACTION: An attempt was made to briefly summarize methodology and findings of relevant studies. No general attempt was made to assess quality of individual studies. RESULTS OF DATA SYNTHESIS: Enteral nutrition appears to be less expensive than parenteral nutrition, but new economic analyses are needed given the newer aggressive access techniques for enteral nutrition. Enteral nutrition is associated with meaningful morbidity and mortality. The little comparative data existent suggest no differences in safety. Comparative studies of physiology and metabolism as well as comparative and noncomparative studies of intestinal function and structure do not support putative advantages of enteral nutrition. There is no evidence that enteral nutrition prevents bacterial translocation in humans. Enteral nutrition probably reduces septic morbidity compared with parenteral nutrition in abdominal trauma. Otherwise, there is no evidence that enteral nutrition consistently improves patient outcome compared with parenteral nutrition. CONCLUSIONS: With the exception of decreased cost and probable reduced septic morbidity in acute abdominal trauma, the available literature does not support the thesis that enteral nutrition is better than parenteral nutrition in humans.

Bacterial Translocation↗
PubMedDate not supplied

Efficacy and safety of total parenteral nutrition.

Total parenteral nutrition has been widely available for almost 20 years. This therapy can demonstrably support growth in neonates and children and will maintain life in adults with an inadequate intestine. It may be beneficial in highly selected preoperative patients, and patients with head trauma. Otherwise, its role in specific disease states or pathologic conditions remains unclear. Whether its benefits outweigh its hazards is largely unknown. Crucial to the decision-making process for initiation of TPN is a knowledge of when starvation becomes detrimental to an individual and whether TPN can prevent or reverse any of starvation's detrimental effects; this information is unknown. Many potential complications exist, the frequency of which generally is dependent on the expertise of the user. Nutritional support teams appear to reduce septic, mechanical, and metabolic complications and may improve the clinical efficacy and decrease the cost of TPN care.

Critical Illness↗