Although PN was initially relatively expensive, its components are often less expensive than specialty enteral formulas. Percutaneous placement of a central venous catheter into the subclavian or internal jugular vein with advancement into the superior vena cava can be accomplished at the bedside by trained personnel using sterile techniques. Peripherally inserted central catheters can also be placed within the lumen in the central vein, but this technique is usually more appropriate for non-ICU patients. The subclavian or internal jugular lines can be changed over a wire, but this carries a greater risk of pneumothorax or serious vascular damage. The. | Chapter 073. Enteral and Parenteral Nutrition Part 4 Although PN was initially relatively expensive its components are often less expensive than specialty enteral formulas. Percutaneous placement of a central venous catheter into the subclavian or internal jugular vein with advancement into the superior vena cava can be accomplished at the bedside by trained personnel using sterile techniques. Peripherally inserted central catheters can also be placed within the lumen in the central vein but this technique is usually more appropriate for non-ICU patients. The subclavian or internal jugular lines can be changed over a wire but this carries a greater risk of pneumothorax or serious vascular damage. The peripherally inserted catheters are subject to position-related flow and the catheter cannot be changed over a wire. Inserting a nasogastric tube is a bedside procedure but many critically ill patients have impaired gastric emptying that increases the risk of aspiration pneumonia. This risk can be reduced by feeding directly into the jejunum beyond the ligament of Treitz. This usually requires fluoroscopic guidance or endoscopic placement. In patients who have planned laparotomies or other conditions likely to require a prolonged need for SNS it is advantageous to place a jejunal feeding tube at the time of surgery. Although most SNS is delivered in hospitals some patients require it on a long-term basis. If they have a safe environment and a willingness to learn the self-care techniques SNS can be administered at home. The clinical outcomes of patients with severe intestinal disorders treated with home PN or EN are summarized in Table 73-2. PN infused at home is usually cycled overnight to give greater daytime freedom. Other important considerations in determining the appropriateness of home PN or EN are that the patient s prognosis is longer than several months and that the therapy benefits quality of life. Table 73-2 Summary of Outcomes for Patients on Home .
