caa a22 4500 475802098 CHVBK 20180406123740.0 cr unu---uuuuu 170329e20001201xx s 000 0 eng 10.1007/s002680010264 doi (NATIONALLICENCE)springer-10.1007/s002680010264 Access Routes for Nutritional Therapy [Elektronische Daten] [Dan L. Waitzberg, Caio Plopper, Ricardo M. Terra] Enteral nutrition (EN) and total parenteral nutrition (TPN) may provide life-sustaining therapy for surgical patients. The duration of nutritional therapy (enteral or parenteral) implies distinct access routes. We review the main aspects related to access routes for nutrient delivery. The enteral route, whenever feasible, is preferred. For EN lasting less than 6 weeks, nasoenteric tubes are the route of choice. Conversely, enterostomy tubes should be used for longer-term enteral feeding and can be placed surgically or with fluoroscopic and endoscopic assistance. The first choice for patients who will not be submitted to laparotomy is percutaneous endoscopic gastrostomy. Postpyloric access, although not consensual, must be considered when there is a high risk of aspiration. For intravenous delivery of nutrients lasting less than 10 days, the peripheral route can be used. However, because of frequent infusion phlebitis, its role is still in discussion. Central venous catheters (CVCs) for TPN delivery may be (1) nonimplantable, percutaneous, nontunneled—used for a few days to 3 to 4 weeks; (2) partially implantable, percutaneous, tunneled—used for longer periods and permanent access; or (3) totally implantable subcutaneous ports—also used for long-term or permanent access. The subclavian vein is usually the insertion site of choice for central venous catheters. Implantable ports are associated with lower rates of septic complications than percutaneous CVCs. The catheter with the least number of necessary lumens should be applied. Central venous nutrient delivery can also be accomplished through peripherally inserted central catheters, which avoid insertion-related risks. Société Internationale de Chirurgie, 2000 Waitzberg Dan L. aut Plopper Caio aut Terra Ricardo M. aut World Journal of Surgery Springer-Verlag 24/12(2000-12-01), 1468-1476 0364-2313 24:12<1468 2000 24 268 https://doi.org/10.1007/s002680010264 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002680010264 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Waitzberg Dan L. aut NATIONALLICENCE 700 1- Plopper Caio aut NATIONALLICENCE 700 1- Terra Ricardo M. aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/12(2000-12-01), 1468-1476 0364-2313 24:12<1468 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer