Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.
Discipline of Surgery, Westmead Clinical School, the Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Colorectal Dis. 2021 Jul;23(7):1924-1929. doi: 10.1111/codi.15643. Epub 2021 Apr 8.
High-output enterocutaneous fistulas (ECFs) are an established cause of intestinal failure. Parenteral nutrition (PN) remains the gold standard for nutritional management but is complex, expensive and associated with significant complications. Chyme reinfusion (CR) has been reported by multiple centres as a viable option for nutritional management that improves nutritional status, provides the capacity to cease PN and is cost-effective. The aim of this paper is to describe the first use of a novel pump device (The Insides System™) by an independent centre in Australia for the nutritional management of a patient with high-output ECF.
CR was performed on a 66-year-old woman with a high-output ECF. The device consists of two main components: a centrifugal pump that sits inside the stoma appliance and a battery-powered driver that is magnetically coupled externally onto the pump. The device allows for bolus CR at a rate of infusion that is manually controlled by the patient based on comfort, volume and effluent viscosity.
CR provided adequate nutritional support, with successful cessation of PN. Effective use of the device was learnt easily by the patient with minimal demands on nursing assistance. Side effects of CR (diarrhoea, abdominal cramping) were overcome by the patient's ability to manually adjust the reinfusion rate.
Our experience with the novel Insides System™ device showed promising results in maintaining nutritional status as well as providing a minimally invasive, easy to use and low-cost system for CR. CR should be considered as a viable alternative for the nutritional management of patients with a high-output ECF.
高输出性肠外瘘（ECF）是肠衰竭的一个公认病因。肠外营养（PN）仍然是营养管理的金标准，但它复杂、昂贵，且会引起严重并发症。多个中心报道称，采用再输注技术（CR）是一种可行的营养管理选择，它可改善营养状况，使患者能够停止 PN，并具有成本效益。本文旨在描述澳大利亚一个独立中心首次使用新型泵设备（Insides System™）为高输出性 ECF 患者进行营养管理。
对一名 66 岁女性的高输出性 ECF 进行 CR。该设备由两个主要部分组成：一个位于造口器械内的离心式泵，以及一个由外部磁耦合到泵上的电池供电驱动器。该设备允许以手动控制的方式进行 CR，患者可根据舒适度、容量和流出物黏度来控制输注速度。
CR 提供了充足的营养支持，并成功停止了 PN。患者很容易就学会了有效地使用该设备，仅需极少的护理协助。通过患者手动调整再输注率，成功克服了 CR 的副作用（腹泻、腹部绞痛）。
我们使用新型 Insides System™设备的经验表明，该设备在维持营养状况方面具有良好的效果，同时提供了一种微创、易于使用且低成本的 CR 系统。对于高输出性 ECF 患者的营养管理，CR 应被视为一种可行的替代方法。
