The nutritional management of a central venous incident

Abstract

A central venous incident (CVI) is the second leading cause of death worldwide, and is associated with permanent disabilities.There are many nutrition and lifestyle modifiable risk factors for a CVI. These include diabetes, and hypercholesterolaemia and hypertension, all of which are largely preventable, and involve effective, low-cost treatment. Malnutrition in CVI patients ranges from 6-62%, and often worsens during hospitalisation owing to multiple factors, including dysphagia, the inadequate intake of food, inactivity and metabolic changes in the clinical setting. When malnutrition is present in patients who have an acute CVI, the increased risk of poor functional outcomes relates to complications such as gastrointestinal bleeding, pressure ulcers, and urinary tract and respiratory infections. These are associated with higher mortality and increased length of stay in hospital, and contribute to decreased quality of life and impaired rehabilitative outcomes. Screening and nutritional assessment is vital on admission. The Mini Nutritional Assessment and Patient-Generated Subjective Global Assessment have been validated in this patient population. The energy and protein requirements of stroke patients are poorly defined. There is some evidence for the supplementation of antioxidants, but the efficacy thereof depends on their ability to cross the blood-brain-barrier. Large-scale studies are necessary to assess the effect on neurocognitive recovery. Meeting requirements in this patient population is a challenge because of dysphagia, as well as neurological and cognitive deficiencies, and is best achieved with the support of a multidisciplinary team. Early enteral nutrition improves survival, while oral nutrition supplements improve nutrient intake and quality of life.