Management of type 1 (acute) intestinal failure.

Abstract

Intestinal failure (IF) is defined as 'the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth'. Type 1 IF is short-term and often perioperative in nature. Patients are managed in a multitude of healthcare settings, particularly surgical and critical care areas. Type 1 IF can lead to malnutrition, which is prevalent in hospitals and has significant consequences for patient outcomes. Type 1 IF patients require short-term parenteral nutrition (PN) support; the provision of PN in hospitals should be managed by a multidisciplinary nutrition support team (NST).Nutritional assessment should include estimating requirements for energy, protein, fluid and electrolytes, based on basal requirements with adjustments for higher demands. All patients should be assessed for risk of refeeding syndrome and managed appropriately. Most patients can be managed using multichamber PN bags. A small minority may require bespoke PN. PN should always be provided with micronutrients and electrolytes.A central venous catheter is the preferred choice for venous access. All intravenous devices used for PN should be handled using an aseptic non-touch technique. If a catheter-related bloodstream infection is suspected, the diagnosis should be made using paired blood culture sampling.All patients should undergo ward-based and blood monitoring. The frequency of monitoring may be reduced if PN continues for a longer duration, under NST advice. Daily assessment should also include monitoring for signs of resolution of IF, and the introduction of oral/enteral nutrition.