Subcutaneously Implanted Enteral Nutrition Port

Abstract

Background: Patients who have undergone esophagectomy with extensive lymph node dissection under thoracolapalotomy for advanced esophageal carcinomas frequently need long-term nutrition support because of their inadequate oral intake. We have used tube enterostomy feeding for these patients not only immediately after the operations but also at home to prevent the development of malnutrition. Patients who receive long-term tube enterostomy feeding often suffer from skin problems around the enteral nutrition catheters. Once the catheter is removed, the patient with anticipated malnutrition is subsequently unable to receive beneficial enteral nutrition. We have developed a new enteral access system that is placed subcutaneously. This subcutaneously implanted enteral nutrition port makes possible intermittent and long-term enteral nutrition support not only for the postoperative period but also for home care. Methods: This system consists of the port (Infuse-a-Port, SMAP15 Snaplock Macro-Port Venous Access System; Strato Medical Co) and the enteral nutrition tube (Enteral Tube 8F, 75 cm; Zeon Co). This system was applied to seven patients who had undergone esophagectomy. The port was placed on the lower chest subcutaneously, and the catheter was placed through the gastric tube and duodenum up to the jejunum. After the operation, a 20-gauge port needle was placed, and enteral nutrition formula (Enterued; Termo Co) was started with the enteral nutrition pump. Results: No complications (eg, infection of skin, obstruction of tube) were observed from the postoperative period through the home care stage. The observation period for this implanted system ranged from 2 to 12 months. The patients were able to avoid the malnutrition anticipated after the extensive operations and continued to receive nutrition support safely and effectively at home. Conclusion: This new nutrition support system is safe and efficient for patients who anticipate long-term enteral nutrition support. A subcutaneously implanted enteral nutrition port makes possible intermittent and long-term nutrition support without patient discomfort and inconvenience. (journal of Parenteral and Enteral Nutrition 21:238-240, 1997)

Get full access to this article

View all access options for this article.

References

Goseki N. , Hara Y. , Aoi T. , et al: Enteral nutritional support for major surgery of the digestive organs. Jpn J Gastrointestinal Surg 26 :1169-1174, 1993

Guenter P. , Jones S. , Jacob DO , et al: Administration and delivery of enteral nutrition. IN Clinical Nutrition: Enteral and Tube Feeding, 2nd ed. Rombeau HL , Caldwell MD (eds). WB Saunders, Philadelphia, 1990, pp 192-203

Schlichig R. , Ayres SM : Nutrition consideration for specific disease . IN Nutrition Support of the Clinically III. Schlichtig R , Ayres SM (eds). Mosby Year Book Medical Publishers, Chicago, 1988, pp 185-209

Burt ME , Gorschboth CM , Brennan MF : A controlled, prospective, randomized trial evaluation of the metabolic effects of enteral and parenteral nutrition in cancer patient. Cancer 49:1092-1105, 1982

Daly JM , Dudrick SJ , Copeland EM : Evaluation of nutritional indices as prognostic indicators in the cancer patient . Cancer 43:925-931, 1979

Niederhuber JE , Ensminger W. , Gyges JW , et al: Totally implanted venous and arterial access system to replace external catheters in cancer patients. Surgery 92:706-711, 1982

Hosoda S. , Shimoyama T. , Takahashi T. , et al: Nutritional management of Crohn's disease with a peptide-based enteral formula. Asia Pacific J Clin Nutr 2:63-70, 1993

Nelson JK , Palumbo PJ , O'Brien PC : Home enteral nutrition: Observation of a newly established program . NCP 1:193-199, 1986

American Society for Parenteral and Enteral Nutrition: Standards for Home Nutrition Support. NCP 7:65-69, 1992