P834 - USE OF PARENTERAL NUTRITION FOR PATIENTS WITH SPINAL CORD INJURY IN THE SOUTH EAST OF ENGLAND

P834

USE OF PARENTERAL NUTRITION FOR PATIENTS WITH SPINAL CORD INJURY IN THE SOUTH EAST OF ENGLAND

S. S. H. Wong^1,2,3,*, N. Jayamaha¹, S. Hirani³, A. Forbes⁴, V. Blackwell⁵, N. Hamilton⁶, A. Daulatzai⁶, C. Hillier¹, M. Woodley⁷, S. Swarna^1,2

¹National Spinal Injuries Centre, Stoke Mandeville Hospital, ²Royal Buckinghamshire Hospital, Aylesbury, ³Health Service Research, City St George's, University of London, London, United Kingdom, ⁴Institute of Clinical Medicine, University of Tartu, Tartu, Estonia, ⁵Department of Gastroenterology, ⁶Department of Pharmacy, ⁷OPAT, Stoke Mandeville Hospital, Aylesbury, United Kingdom

Rationale: Patients with spinal cord injury (PWSCI) will require additional protein for pressure ulcer healing. Sometimes, increased provision of enteral nutrition, could mean an increase faecal output, leading to increased risk of faecal contamination when supplementary PN is therefore indicated. The study aim was to report (1) the use of PN use in a spinal cord injury (SCI) centre and (2) the occurrence of metabolic and catheter related blood stream infections (CRBSI).

Methods: A retrospective study was conducted during January 2018 to December 2024. We defined CRBSI as the presence of bacteraemia (positive culture report) from a peripheral vein and from the intravenous catheter.

Results: 2,002 PWSCI were included. Thirty-eight patients (1.9%) (median age: 65 years) with SCI (43.2% tetraplegia) received PN support. PN was used for a median of 35 days (IQ range: 129.5; range: 3-440 days). All PN was commenced by the nutrition team. PN use increased significantly overtime (2019: n=3, 0.8%; 2020: n=4, 1.65%; 2021: n=2, 0.6%; 2022: n=12, 3.5%, 2023: n=8, 2.3%; 2024: n=9, 2.6%, p=0.024). Metabolic complications occurred in 95.2% of PWSCI on PN. The top 3 complications were hyponatraemia (hyponatraemia: serum sodium <130mmol/L: 63.9%), abnormal liver functions tests (61.1%) and hyperglycemia (serum glucose >7mmol/L: 61.1%). Of 2,923 days of PN, 9 confirmed CRBSIs (n=1 in 2021, 2.87 per 1,000 PN days; n=4 in 2022, 4.67 per 1,000 PN days, n=4 in 2023, 13.42 per 1,000 PN days and n=0 in 2024, 0 per 1,000 PN days in 2024; Overall: 3.07 per 1,000 PN days). 

Conclusion: This study suggests a true increase in the use of PN overtime. This work strengthens the case for review of Nutrition Team provision in SCI centres, especially feasibility to set up a partnership with intestinal rehabilitation centre. Routine monitoring and management of metabolic complications in PWSCI on PN should be considered.

Disclosure of Interest: None declared