OC28 Home Parenteral Nutrition (HPN) In Palliative Oncology Patients: A UK Single Centre Case Series

Abstracts / Clinical Nutrition ESPEN 22 (2017) 116e147

Malnourishment is common in cancer patients. Resultant sarcopenia, seen alongside advanced disease, leads to increased rates of perioperative complications, increased rates of infection and decreased tolerance of anti-cancer treatment. A subset of these patients are unable to maintain enteral
nutrition, for instance those with bowel obstruction, and improving nutrition in this group is an area of expanding interest. Since the establishment of home parenteral nutrition (HPN), its use in cancer patients in the UK has increased annually (British Artificial Nutrition Survey 2015). Despite this, literature in this area remains sparse and randomised controlled trials are understandably non-existent. This paper aims to review current practice with HPN in patients with non-curable cancer at a
large teaching hospital in the UK to assess outcomes and suggest areas for future research.

UHCW Research: H. Bridgestock, C. Bell, R. Whitefield, S. Sothi, N. Burch.

Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition

This guideline covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital or in their own home or a care home. It offers advice on how oral, enteral tube feeding and parenteral nutrition support should be started, administered and stopped. It aims to support healthcare professionals identify malnourished people and help them to choose the most appropriate form of support.

This guideline includes recommendations on:

• screening for malnutrition and the risk of malnutrition
• indications for nutrition support
• what nutrition support to give
• monitoring of nutrition support
• oral nutrition support
• enteral tube feeding
• parenteral nutrition

Nasogastric tube misplacement: continuing risk of death and severe harm

A stage two alert has been issued to support providers of NHS-funded care to prevent the risk of severe harm or death caused by the misplacement of nasogastric tubes (NG tubes).

Post-transplant food safety is imperative

Journal of Kidney Care, 2.1 (January 2017): 4.

The British Dietetic Association's (2016) renal transplant guidelines were a welcome addition to clinical practice. They amalgamate up-to-date food safety evidence to guide dietitians in post-transplant nutritional advice. Informed by stem cell transplant research (due to the lack of evidence in renal), the recommendations addressed potential conflicting theoretical dietary advice reflected in differing historical dietetic practice throughout the UK. For example, at one time there was differing advice on the number of months recommended to avoid eating outside the home after a transplant. Now definitive best practice guidelines exist. References

UHCW Research: Andrew Morris

Webinar on nasogastric (NG) tube safety issues – 2pm-3pm Monday 6 March

Incidents of misplaced NG tubes continue to be reported to the National Reporting and Learning System (NRLS). In partnership with Sign up to Safety, NHS Improvement's patient safety team is organising this webinar to address NG tubes safety issues and to hear about your experiences of implementing the NG tube guidance.

Supplementary feeding of preterm babies by cup rather than bottle helps breastfeeding success

For women who chose to breastfeed their preterm baby, supplementary feeds with a cup, compared with a bottle, led to improved breastfeeding rates at discharge and up to six months later.

From the NIHR Dissemination Centre

Simple bedside check for nasogastric tube positioning is cost effective and prevents deaths

In adults who need a nasogastric tube for a short time, pH testing was the best initial approach followed by X-ray confirmation if pH testing wasn’t successful. pH testing was four times less expensive than X-ray confirmation and when used in sequence both were cost effective uses of NHS resources.

From the NIHR Dissemination Centre

Nasogastric tube misplacement: continuing risk of death and severe harm

This alert from NHS Improvement highlights patient safety incidents involving the misplacement of nasogastric and orogastric tubes.

Preterm babies do not benefit from a new IV feeding regimen - NIHR Signal

Intravenous feeding solutions with a higher dose of amino acids or solutions containing fish oils do not provide better outcomes for preterm infants.

Many preterm babies can’t feed normally for the first few weeks after birth so they are given a mixture of protein, carbohydrate and lipid (oil or fat) intravenously. There is wide variation across the UK in terms of the type, composition and regimen of intravenous feeds.

This NIHR-funded NEON trial looked at infants born before 31 weeks. It tested the theory that increasing the amount of amino acids provided in IV feeding fluids may improve lean body mass and that giving more fish oils rather than plant oils may reduce liver problems. The trial findings provide no evidence that higher intakes of amino acids or emulsions containing fish oils are beneficial compared to a standard approach, where the dose of amino acids is slowly increased and soya oil is used.

Infant feeding: commissioning services

Information from Public Health England to support commissioning of local infant feeding services.

Intravenous nutrition is more costly than feeding by stomach tube, with few added benefits

Critically ill people need some form of feeding to give them protein and energy. The NIHR funded this multicentre trial to compare the costs and effects of early intravenous nutritional support with enteral feeding, feeding by tube into the stomach or the intestine. Death rates and other important outcomes were similar when using either route. The intravenous route was associated with lower rates of stomach overfilling, diarrhoea and low blood sugar, but the benefits gained were not great enough to justify the higher costs.

The findings support current practice across NHS critical care units where delivery of early nutritional support is predominantly given via stomach tube.

From the NIHR Dissemination Centre