家庭肠外营养的病人及家属准备

家庭TPN的准备是一个多学科的过程，通常涉及医生、护士、营养师、药师和社会工作者。教育病人时必须包括以下内容：

无菌技术。

对辅助设备的护理，包括导管的冲洗和肝素化、穿刺点护理、更换敷料。

需要时在TPN溶液中加入添加剂。

　TPN输液的开始、给药和终止，包括输液泵的使用。

合并症的症状和体征以及这些合并症的处理；自我监测（例如血糖的监测、定期测体重、需要时测体温、评估脱水状态等）。

经济、第三方支付者以及与家庭TPN相关的供给问题。

参考文献

Alonso-Echanove J et al: Effect of nurse staffing and antimicrobialimpregnated central venous catheters on the risk for bloodstream infections in intensive care units, Infect Control Hosp Epidemiol 24:916,2003.

A.S.P.E.N. Board of Directors and Clinical Guidelines Task Force:Guidelines for the use of parenteral and enteral nutrition in adults and pediatric patients, J Parent Ent Nutr 26(suppl):1SA, 2002.

Centers for Disease Control and Prevention: Guidelines for the prevention of intravascular catheter-related infections, MMWR 51(No. RR-10):1,2002.

Davis A: Initiation, monitoring, and complications of pediatric parenteral nutrition. In Baker BB, Baker RD, Davis A, editors. Pediatric parenteral nutrition, New York, 1997, Chapman & Hall, pp. 212-237.

Koretz RL, Lipman TO, Klein S, American Gastroenterological Association: AGA technical review on parenteral nutrition,Gastroenterology 121:970, 2001.

选择阅读

A.S.P.E.N. Board of Directors and Task Force on Standards for Specialized Nutrition Support for Hospitalized Adult Patients:Standards for specialized nutrition support: adult hospitalized patients,Nutr Clin Prac 17: 384, 2002.

Cowl CT et al: Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters, Clin Nutr 19:237-243, 2000.

Dominguez-Cherit G et al: Total parenteral nutrition, Curr Opin Crit Care 8:285-289, 2002.

Heyland DK et al: Total parenteral nutrition in the surgical patient: a meta-analysis, Can J Surg 44:102-111, 2001.

Irving SY et al: Nutrition for the critically ill child: enteral and parenteral support, AACN Clinical Issues 11:541, 2000.

Klein GL: Aluminum contamination of parenteral nutrition solutions and its impact on the pediatric patient, Nutr Clin Prac 18:302, 2003.

Kumpf VJ: Update on parenteral iron therapy, Nutr Clin Prac 18:318,2003.

Rice H: Fluid therapy for the pediatric surgery patient. Updated June 13,2003. Available at http://www.emedicine.com/ped/topic2954.htm.Accessed January 20, 2004.

Vanek V: The ins and outs of venous access: part I, Nutr Clin Pract 17:85,2002.