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Objectives: The aim of this study was to evaluate the safety and efficacy of home parenteral nutrition (HPN) service in patients with benign chronic intestinal failure (CIF)., Methods: This was a 10-y retrospective, non-interventional, multicenter study conducted with adult and pediatric patients with CIF who received HPN service. We analyzed data prospectively collected from a dedicated register by HPN nurses., Results: From January 2002 to December 2011 a total of 794 patients (49.7% male, median age 1 y for children and 57 y for adults) were included in the analysis. Over the 10-y period, 723 central venous catheter (CVC) complications occurred, of which 394 were infectious (54.5%), 297 were mechanical (41.1%), and 32 (3.3%) were defined as CVC-related thrombosis. The complication rate was higher in children (1.11 per patient) than in adults (0.70 per patient). During the observation period, the rates of both infectious and mechanical complications showed a global declining trend and ∼75% of patients had neither infectious nor mechanical CVC complications. HPN efficacy was evaluated in 301 patients with a minimum follow-up of 36 mo. Body mass index and Karnofsky score showed that the median growth significantly increased (P < 0.001) over baseline for adults and pediatric patients in the 0 to 2 age range., Conclusions: The use of a structured register has proved to be a key strategy for monitoring the outcomes of long-term treatment, improving time efficiency, and preventing potential malpractice. To our knowledge, this is the largest survey ever documented; the results were consistent despite the heterogeneity of the centers because of duly applied standard rules and protocols., (Copyright © 2019. Published by Elsevier Inc.)

This article explores the complexities of home parenteral nutrition (HPN) and how it has developed as a home therapy. It examines the various indications and treatment options, discussing access and the associated complications. The relationship between the multiprofessional team is paramount to the success of the therapy. Working in partnership with home-care providers is also discussed. It gives an overview of patients receiving parenteral nutrition at home and the impact it has on their lives.

In children, surgical conditions of the abdomen can present with rather non-specific symptoms akin to other common, self-limiting pathologies. These factors can impede diagnosis and the rapid specialist management that is often required. Community practitioners are often the first health professional to see the sick child and advise their caregivers. Therefore it is of upmost importance that they are equipped and confident in their knowledge of the potential surgical conditions that they may encounter in their clinical practice. Suspicion of a serious surgical disorder or a deteriorating child warrants prompt referral to a medical professional. This article aims to provide an overview of the most common abdominal surgical conditions in children and to provide information and suggestions to the community practitioner in order to broadly enhance their outcomes.

The video capsule endoscopy is an accurate tool to investigate the entire small bowel. Currently, the nurse actively participates in the procedure from patient preparation to the video download, whereas a gastroenterologist interprets the endoscopic findings. However, few studies recently showed high accuracy of nurses in detecting lesions in the small bowel on video capsule endoscopy recordings. This prospective study aimed to assess the ability of experienced and trained nurses in detecting small bowel lesions as compared with gastroenterologists. Forty-six consecutive video capsule endoscopy procedures were analyzed. Overall, the nurse evaluation was highly (95.6%) accurate in detecting small bowel lesions, with a 100% concordance with the gastroenterologist for the relevant findings. In addition, the absence of lesions was confirmed by the endoscopist in all cases classified as negative by the nurse. Data of this study found that trained nurses, with a large experience in endoscopic features, correctly identified small bowel lesions on video capsule endoscopy recordings. Therefore, a trained nurse may accurately select the thumbnails of all mucosal irregularities that may be faster reviewed by the endoscopist for a final diagnosis.

Background: Children with intestinal failure (IF) have frequent catheter-related bloodstream infections (CRBSIs). The purpose of this study was to prospectively study the clinical course of CRBSIs and to seek modifiable risk factors for CRBSIs in children with IF., Materials and Methods: Children with IF were enrolled prospectively and data on potential risk factors collected monthly. Additional data were collected when they had CRBSIs., Results: Sixteen children were enrolled, yielding 223 months of data. The rate of CRBSIs was 4.6 per 1000 catheter days. The most consistent symptom at onset of CRBSI was fever (28 of 32 cases). Elevated C-reactive protein (CRP) was the only laboratory abnormality that was consistently associated with the onset of CRBSI (elevated in 15 of the 18 cases where it was measured). Combining all episodes in the cases that relapsed, the catheter salvage rate was 17 of 29 (59%), including 4 of 11 polymicrobial CRBSIs. Risk factors for CRBSI included double lumen tunneled central venous catheter (CVC), jugular placement of CVC, higher doses of intralipid, and having <50 cm small bowel postresection., Conclusion: The diagnosis of CRBSI should be questioned in the absence of fever and/or elevated CRP. Salvage of catheters should be attempted with all bacterial CRBSIs, assuming that the child is stable since the CVC can be retained in the majority of cases., (© 2013 American Society for Parenteral and Enteral Nutrition.)

Working in isolation, managing high-output stomas can be stressful and difficult, with patient outcomes varying significantly. For the stoma care clinical nurse specialist, managing the choice of stoma appliance is only a small part of the care provided. To standardise and improve outcomes for patients with high-output stomas, team working is required. After contacting other stoma care services and using guidance from the High Impact Actions for Stoma Care document ( Coloplast, 2010 ), it was evident that the team should put together an algorithm/flow chart to guide both specialists and ward nursing staff in the evidence-based and standardised management of patients with high-output stomas. This article presents the flowchart that was produced and uses case studies to demonstrate improvements.

Purpose: Children with intestinal failure (IF) have complex needs that pose many challenges while in the hospital and upon transition to home. The purpose of this review was to identify factors associated with the complexity of transitional care in this population of children, as well as to explore frameworks for providing care for transition to home., Design and Method: Eleven publications, including research and clinical practice articles, were identified for an integrative review., Results: Four themes emerged regarding IF and transition: complex healthcare needs, planning for and beginning transition, identification of family requirements, and frameworks for providing transitional care., Practice Implications: Nurses working with families of children with IF can facilitate successful transition into the home by planning in advance and using a framework that addresses the needs of the patient and family., (© 2012, Wiley Periodicals, Inc.)

Background and Aims: Parenteral nutrition is life-saving for patients with severe intestinal failure. Line-related blood stream infection is the most frequent complication and strategies have been developed to sterilize central lines. Nevertheless, failures of attempted sterilization are not well understood., Methods: 19 ports were explanted from 19 patients receiving parenteral nutrition because of port-related blood stream infection and failed sterilization, defined as a) recurrence of the same organism after a recent sterilization attempt <90 days), b) recovery of the causative organism after 10 days of proper antibiotic therapy or c) insufficient clinical improvement. Port chambers were opened and swabs were examined by culture., Results: Pathogens resembled those typically found in successfully treated line-related blood stream infection. Despite proper therapy for a median of 6.5 days the same pathogen was recovered from 18/19 chambers. In 9/19 chambers visible debris were found, from which the pathogen could be cultured., Conclusions: Infected debris or infected biofilms in the chamber are the reason for failure to sterilize a port. Lock techniques, single lumen tunneled catheters or in certain settings the exchange of only the port chamber may be approaches to prevent, circumvent or treat failures of attempted sterilization of an infected port system., (© Georg Thieme Verlag KG Stuttgart · New York.)

Catheter-related bloodstream infection is a major cause of mortality and morbidity in the intestinal-failure population. This study reports characteristics of CRBSI with implications for clinical management in parenteral nutrition-dependent children with intestinal failure. The researchers report the rate of central catheter infections, and the causative organisms, as well as identify risk factors in our intestinal-failure patients that would be amenable to preventive measures.The study is a retrospective review of the medical records of 101 patients with intestinal failure (IF), seen in the Intestinal Rehabilitation Clinic at Children's Medical Center of Dallas from May 2005 to March 2007. Catheter-related bloodstream infections (CRBSIs) were categorized as nosocomial or community-acquired. Data collected for each episode include microorganisms isolated from blood and potential risk factors. Z test was done to compare the infection rates.There were 92 episodes of CRBSIs in 45 parenteral nutrition (PN)-dependent patients with central venous catheters (CVC) in place for a total of 13,978 days. Eighty-three percent (n = 76) of CRBSIs developed in the community at a rate of 7.0 per 1,000 days. Seventeen percent (n = 16) nosocomial CRBSIs were observed at a rate of 5.5 per 1,000 catheter days. CRBSI rate was not statistically different between the two groups (7.0 vs. 5.5, p = .378).CRBSI in the intestinal-failure population is due to a wide variety of organisms with numerous risk factors. Education of CVC management with the practice of consistent guidelines may reduce CRBSI incidence, thus reducing the morbidity and mortality in the intestinal-failure patients.

Background: Capsule endoscopy is a common, pain-free diagnostic procedure for the small bowel. However, interpretation of the whole video recording is a time-consuming and costly procedure that can take up to 2 hours. The aim of the present study is two-fold: first to study the accuracy of capsule endoscopy analysis between a trained endoscopy nurse and a physician and secondly to determine if pre-evaluation by nursing staff might be time-effective for capsule reading. This study is especially important given the increasing financial pressure on current health-care systems., Methods: A long-standing experienced endoscopy nurse, who was trained to read capsule endoscopy, and a physician, both blinded to the patient diagnosis and the other clinical findings reviewed 48 consecutive capsule endoscopy videos. The analyses of both the nurse and the physician were re-evaluated by an independent doctor regarding the agreement of the marked findings., Results: Total time to read capsule endoscopy was significantly longer for the nurse's interpretation (63 +/- 26 min) as compared to the physician's interpretation (54 +/- 18 min, p < 0.01). The endoscopy nurse marked 236 thumbnails, whereas the doctor only marked 132 thumbnails. The nurse overlooked 4 of 64 relevant lesions (6 %), which had been detected by the physician. These overlooked lesions were not single important lesions, they were overlooked only in patients with multiple angiectasias of the small intestine, and thus the misdiagnosis was without clinical relevance. The physician overlooked 6 of 68 lesions detected by the nurse (9 %), also in patients with multiple angiodysplastic lesions and therefore without clinical relevance. On post-hoc analysis of the capsule video recordings the time needed by the physician to interpret the thumbnails marked by the nurse was 10 +/- 12 min. While there was no difference with respect to the estimated gastric emptying time (nurse 27 +/- 13 min vs. physician 28 +/- 14 min, n. s.), the estimated time of capsule passage through the ileocaecal valve was longer when interpreted by the endoscopy nurse (nurse 347 +/- 89 min vs. physician 326 +/- 74 min, n. s.). Nevertheless, the total cost for capsule pre-evaluation by the nurse was lower (13.23 euro vs. physician 17.82 euro)., Conclusion: The endoscopy nurse detected 94 % of the significant lesions seen by the physician and no clinically relevant findings were overlooked. A pre-evaluation of the capsule video by trained staff is an accurate method and might be time effective.

The formation of an intestinal stoma is one of the most frequent operations in visceral surgery. Despite new operative techniques and a more restrictive use of the stoma, the stoma formation remains an often necessary surgical procedure, which results to a dramatic change in the patients' life. The stoma formation and its later closure are associated with a high morbidity. Many complications, such as stoma necrosis, stoma retraction or stoma prolapse, are related to surgical mistakes made during stoma formation. These complications are therefore largely avoidable. The stoma formation needs careful planning together with a professional stoma nursing team. Moreover, it is mandatory that the stoma formation is made with great care and that it meticulously follows the well established surgical principles. A perfectly placed, technically correctly fashioned and easy to care for stoma is essential for a good patients'quality of life.

Intestinal failure and a high faecal output from a stoma or fistula are rare gastrointestinal complications. Intestinal failure occurs when the intestine fails to absorb sufficient fluids and nutrients to maintain life, and can result from bowel resection or malabsorption. The management of these conditions raises many issues which nurses caring for affected patients need to consider. This article will discuss those relating to feeding, appliances and medication. Two methods of feeding that can be useful in patients with intestinal failure, namely parenteral nutrition (intravenous feeding) and fistuloclysis (feeding via an intestinal fistula), will be explored. Finally, a short case study will be presented to highlight the effects of some of these interventions and the problems that they can cause for patients.

Intestinal nutrition has an optimal range of applications and a wide variety of methods for use, both in composition and in osmolarity, adapted to different pathologies. This facilitated the use of intestinal nutrition for each specific case, whether the patient be an adult or a child, by means of feeds or catheters of varying calibres or access methods.

Bed ridden patients commonly suffer a series of intestinal disorders which include: loss of appetite, swallowing disorders, a tendency to undergo gastric tract reflux, slowness in intestinal movements, accumulation of gas or fecal impactation. These contribute to an increased risk of potentially dangerous complications such as intestinal obstruction which can lead to necrosis or a perforation of different parts of the digestive tract, duodenal ulcer, hemorrhoids, or anal fissures.

This article reviews the origins and background of probiotics. Evidence for the potential mechanisms of probiotics and prebiotics, and their interactions with the gastrointestinal tract and the immune system are discussed. Evidence is examined for the use of probiotics to treat infantile diarrhoea, irritable bowel syndrome, inflammatory bowel disease and atopic dermatitis.

Rachel Gilbert discusses the importance of adequate fluid intake for bladder and bowel health and the nurse's role in assessing and managing fluid balance.

Purpose: To describe the experience of families with previously colicky infants., Study Design: This qualitative, descriptive study explored parents' perspectives of the lasting effects of infant colic on their children's development and on their family relationships., Methods: Through in-depth interviews, the parents had the opportunity to share what they remembered most about this experience. Participants volunteered by accessing the Infant Colic Study Web site advertised on numerous search engines. Forty-four participants, all of whom had an infant with colic at some time in the past, answered open-ended questions regarding their feelings about the colicky period and how their children developed later. Data were analyzed from a phenomenologic perspective., Results: The majority of participants reported no later problems in their previously colicky children. Some did believe, however, that family relationships had been affected by the colic experience, and that communication and support had been impaired. Most described feelings about the colic experience that were negative., Clinical Implications: Continued support needs to be provided to families of colicky infants throughout their growth and development at a primary care level. Nurses need to recognize that the experience of infant colic may have residual effects on the entire family unit. These families need to be provided with the support and resources to enable them to successfully care for their children and to engage in nurturing relationships.

Adequate bowel preparation is necessary for several diagnostic and surgical procedures. Inpatients appeared to be less adequately prepared than outpatients at the author's 100-bed hospital. A problem frequently encountered was incomplete administration of the ordered bowel preparation. Surgeons, gastroenterologists, and nurses from the endoscopy laboratory and medical-surgical floor were consulted for development of an order set to enhance completion of bowel preparation for inpatients.

Novice researchers, when confronted with a clinical problem they want to study, are admonished by more experienced researchers to search the literature for an instrument that already has established reliability and validity, fits the problem of study, or that can be easily adapted. Sometimes, however, there is no such instrument available so the researcher has to develop a new instrument. The purpose of this article is to describe the steps required to develop and psychometrically test a new instrument. A new instrument, the Infant Colic Scale, is used as an example.

Background: Colic, a condition that is well known to parents and nurses working in child health centres, is characterized by excessive crying. However, the criteria for defining colic are vague, there is no agreed definition and no effective treatment exists. Even though there is no cure for colic, nurses in child health centres have to deal with the condition as parents bring their crying infants to them., Aim: To develop an understanding of how nurses deal with infant colic/excessive crying, how the parents perceive nurses' contribution, and whether nursing makes a difference to the situation or not., Ethical Issues and Approval: The project was reviewed and approved by the Research Ethics Committee in Norway where the study was carried out., Methods: The design is explorative, and data were collected through qualitative in-depth interviews with nurses and parents of crying infants. The analysis follows the guidelines of Kvale, which imply a phenomenological/hermeneutical mode of understanding., Findings: The primary aim of nursing is to assist parents in their efforts to cope with the challenges of infant colic. Nurses and parents differ to some extent in how they define the problems and the needs of the families. In addition, both parents and nurses question the nurses' knowledge and ability to help in this situation. A relationship with the parents based on trust is fundamental to enable the nurses to achieve their goals, but such a relationship is not always developed., Conclusions: Even though nursing interventions do not cure infant colic, the amount of crying may be reduced and life made easier for the families if the parents are offered help in coping with the situation. Consequently, this should be the primary aim of nursing when approaching families with a colicky infant.

In an era of dwindling reimbursement and rising healthcare costs, the impact of nurse staffing models on patient outcomes is a key concern. This study used a descriptive comparison design to examine the effects of a change in the staffing model on length of stay, variable cost, patient satisfaction, incidence of urinary tract infection and penumonia, and pain management in bowel resection patients. There were significant differences in the pain management outcomes between the two staffing models. Other patient outcomes were comparable despite decreasing the total number of caregivers on the unit. Recommendations for further research are discussed.

It is estimated that 19 million people in the United States may suffer from diseases related to the small intestine, including obscure bleeding, irritable bowel syndrome, Crohns disease, chronic diarrhea, and cancer. Current diagnostic methods, including push enteroscopy and radiology, produce historically low diagnostic yield. Early studies show that the M2A Capsule Endoscope effectively visualizes the entire small bowel and demonstrates a 71% superior diagnostic yield when compared to push enteroscopy according to clinical trials reviewed by the FDA. In addition to potentially higher diagnostic yields, it provides a noninvasive diagnostic alternative where none previously existed. The M2A Capsule Endoscope received FDA clearance in August 2001 and is currently in use at major medical centers throughout the United States and Europe.

An intraoperative critical incident occurred which questioned the validity of the practice of clean and dirty technique in bowel surgery and its role in the prevention of postoperative wound infections. Following the incident, a literature review and a clinical audit were conducted to determine the recommended use of this technique, and to explore its application in clinical practice. The results of the review and the audit are presented and a list of recommendations for practice is made.

This article highlights the importance of providing information that meets the needs of surgical patients. Focus group interviews were used to ask patients who had undergone major bowel surgery what information they felt was required to help prepare someone for this experience. A group of patients who had recently had bowel surgery were interviewed by two facilitators. This technique allowed the participants to identify and verify the issues of concern and to originate new ideas through group discussion. The participants identified many issues that would not have been considered by the authors, issues that were used to form the content of three information booklets for patients having bowel surgery.

Background: Nurses need to have a clear understanding of the reasons for effective bowel preparation for patients undergoing imaging of the rectum and colon., Conclusion: Depending on the specific investigation, a variety of effective oral and rectal preparations are available. One of the most important deciding factors in choosing which should be used is patient tolerance.

Intestinal transplantation offers hope to children with intestinal failure and life-threatening complications of parenteral nutrition (PN). As more transplant centers are adding intestinal transplantation to their existing programs, new challenges are presented to nursing professionals. This three-part series will provide information for nursing professionals regarding evaluation for intestinal transplantation, donor preparation, the surgical procedure, immediate postoperative care of the transplant recipient, complications of intestinal transplantation, and long-term care of the intestinal transplant patient. Part 1 will discuss the indications for intestinal transplantation, the evaluation of patients for intestinal transplantation, the process of listing patients for intestinal transplantation, and the waiting time for donor organs for intestinal transplantation. The information presented represents the approach taken at University of Nebraska Medical Center.

How families appraise difficult situations contributes to later adaptive functioning. We have observed in both research and practice that when appraising their infants' crying, mothers often compared their own infants' crying to actual or supposed much worse infants. They typically appraised their infants to be crying less than average infants. This phenomenon, defined in the social psychology literature, is called downward comparison. Secondary analysis of an established data set was used to assess the extent of downward comparison and the identification of excessive crying among a sample of 193 primiparous mothers. Mothers appraised their own infants' crying to be less than that of the expected average infant. Mothers who identified their infants as excessive criers made less robust downward comparisons than did mothers who did not identify their infants as excessive criers. Nursing interventions that focus on supporting mothers' positive appraisal and promoting knowledge of infant behaviors, particularly infant crying, are proposed.

The results reported were obtained from the findings of a larger descriptive study that surveyed the support needs of 56 mothers of high-risk premature infants. Forty-eight percent of the mothers found the first week after their infant's discharge home difficult. Data analysis indicated the more premature the infant (birth weight r = 0.29, P = 0.03; gestational age r = 0.34, P = 0.008), and the greater the severity of illness as determined by length of hospital stay (r = -0.27, P = 0.04), the more likely the mother was to have a difficult first postdischarge week. The visit of the community health nurse during that first week was a significant factor in whether the mothers perceived the time as difficult (Fisher's exact test, P = 0.02). It was found, as well, that the community health nurses were less likely to visit mothers of very low-birth-weight infants during that week (Fisher's exact test, P = 0.02). Other variables related to difficulty during the first week were whether the infants had apnea in hospital (r = 0.33, P = 0.01), mothers' need for specific kinds of information such as knowledge about colic (chi 2 = 24.31, df = 12, P = 0.02), and an earlier scheduled visit to a physician for mothers whose infants were of lower birth weight (r = -0.26, P = 0.05), earlier gestational age (r = -0.34, P = 0.009), and had spent longer time in hospital (r = 0.37, P = 0.006).

"Persistent" crying has been labeled a developmental crises of parenthood, given the feelings of inadequacy it engenders in new parents. Nearly one of five infants has colic, or more than 700,000 infants in the United States each year. Because there is no "cure" for colic, therapeutic approaches are generally aimed at "containment" of the crying. Such approaches can be classified as feeding/formula modifications, pharmacological agents, and sensory stimulation approaches. This report examines the evidence supporting or refuting the utility of each approach.