PP387 EXPERIENCES WITH CENTRAL VENOUS ACCES PORT AS VENOUS ACCESS FOR HPN

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Poster presentations

Conclusion: The novel protein mixture renders tube feed N1 4 non-coagulating after in vitro stomach digestion. Disclosure of Interest: C. van den Braak: Employee of Danone Research, Centre for Specialised Nutrition, M. Klebach: Employee of Danone Research, Centre for Specialised Nutrition. M. Minor: None declared. Z. Hofman: Employee of Danone Research, Centre for Specialised Nutrition. T. Ludwig: Employee of Danone Research, Centre for Specialised Nutrition.

PP386 PRACTICAL ADULT PARENTERAL NUTRITION PRESCRIBING REDUCES BAG WASTAGE P. Austin1 , J. Palmer1 , M. Elia2 . 1 Pharmacy, 2 Institute of Human Nutrition, Southampton University Hospitals NHS Trust, Southampton, United Kingdom Rationale: Prescribed parenteral nutrition (PN) is not always given to the intended patient due to a change in clinical status. Avoiding unnecessary minor electrolyte variations when prescribing PN may improve the rate of bag reuse for other patients. Methods: Two changes were made to historical practice. First, pharmacy improving prescriber awareness of any bags available for reuse. Second, prescribers adopting a practical approach of accepting premade bags without making minor electrolyte modifications but which still meet patient requirements. Only appropriately stored bags within their expiry were considered for reuse and new bags were prepared when indicated. Historical data was obtained from pharmacy records. All bags were a similar composition and from the same manufacturer. All statistics used a 2-tailed Chisquared test. Results: The table shows the results. Table 11 month period

Historical

New practice

Total bags prepared Bags used for intended patient Bags not used for intended patient Bags reused Bags wasted

2357 2274 83 23 60

3389 3231 158 114 44

The new practice reduced wasted bags (2.5% vs 1.3% of the total number prepared, p < 0.001) and this underscores the improved bag reuse rate because the proportion of available bags from the total compounded was greater in the second period (3.5% vs 4.7%, p = 0.034). 1% of all compounded bags was historically reused (of 3.5% available for reuse 2.5% were wasted) compared to 3.4% of all compounded bags with the new practice (of 4.7% available for reuse 1.3% were wasted). Considering only the bags available for reuse, the new practice reduced the bags wasted (72% vs 28%). Conclusion: A significant reduction in PN bag wastage resulting from an increased bag reuse can occur using a more practical approach to prescribing and improving awareness of bags available for reuse whilst still prescribing clinically appropriate regimens. Disclosure of Interest: None declared

PP387 EXPERIENCES WITH CENTRAL VENOUS ACCES PORT AS VENOUS ACCESS FOR HPN N. Rotovnik Kozjek1 , L. Petrica1 . 1 Clinical Nutrition Unit, Institute of Oncology, Ljubljana, Slovenia Rationale: Venous access ports (VAPs) are totally implanted devices which are used in patients receiving long parenteral treatments. Regarding recommendations this was not usual venous route for home parenteral nutrition (HPN). Despite some advantages of TID (totally implanted devices), skin tunneled central venous catheters continue to be commonly used for HPN. As the local situation in our hospital was in favor of using VAPs we decided to use this device for our group of patients on HPN. The aim of this retrospective study was to analyse the complications of VAPs use in our patients on HPN. Methods: We analysed the records of all our patients patients on HPN since the beginning of their treatment (clinical diagnosis, underlying conditions, date of VAP, number of days, all significant events during treatment). Results: From August 2008 to the end of March 2010, 29 VAPs were inserted to 22 patients. 13 of them were/are paliative cancer patients, 9 patients need HPN because of malabsortion or short bowel syndrome. 5 cancer patients died in less than 2 months (14 to 50 days) and they didn’t have any catheter related complications. 2 cancer patients had VAPs inserted 184 and 230 days with no catheter related complications before they died. 6 paliative cancer patient are on HPN 217 to 422 days. In 1 patient we were able to discontinue HPN after 219 days. 1 VAP has been reinserted because of infection and 1 because of skin necrosis. The other 9 patients have VAPs inserted 72 540 days. In this group 5 VAPs were reinserted. There were 4 infections and 1 mechanical failure of VAPs catheter. The overall complications rate was 24.14%. Conclusion: Incidence of associated VAP-use complications is in the range of known complications from literature. Regarding this we will continue to use VAPs as a vascular acces device for HPN. Disclosure of Interest: None declared

PP388 NUTRITIONAL SUPPORT IN HOSPITAL PATIENTS; WHAT IS THE ROLE OF PERMISSIVE UNDERFEEDING? A.E. Owais1 , R. Bumby1 , J. MacFie1 . 1 General Surgery, Scarborough Combined Gastroenterology research unit, Scarborough, United Kingdom Rationale: The importance of adequate nutritional support in selected patient groups is now well established. Traditionally, the amounts of macronutrients provided have been based upon a perceived need to achieve, if not exceed, energy and protein balance. In recent years there has been increasing interest in the concept of “permissive underfeeding”. The objective of this review was an attempt to determine whether or not there is evidence of benefit for permissive underfeeding in selected groups. Methods: Studies were identified from Medline, Embase and PubMed databases and the Cochrane collaboration. The search was limited from January 1950 to January