Team approach to long-term intravenous feeding in patients with gastrointestinal disorders.

A system has been developed for the prolonged administration of intravenous feeding in general wards. The service is coordinated by a clinician, specialist nurse, and pharmacist. Under local anaesthesia a silicone-rubber catheter is introduced through an infraclavicular incision to create a skin tunnel. By this technique 22 of 27 treatment periods (mean duration 42 days) required the use of only one catheter each. Ward care is simplified by the use of 3 litre bags containing aminoacids, glucose, electrolytes, and trace elements. The bags are prepared under laminar-flow conditions by a pharmacist in a specially designed room. Vitamins are added to the mixture and 'Intralipid" is infused separately as needed. In 38 treatment periods over a total of 1551 days weight-gain and gain in fat-free mass when required were satisfactory; the weight-gain correlated with increase in arm-muscle cross-sectional area (r = 0.72). Patients who have learnt to use the catheter have left the hospital for periods of up to 3 days, and 2 patients have given themselves intravenous supplements regularly at night in their homes.