Background:There has been a shift toward combined liver-intestine and multivisceral transplantation (MVT), whereas isolated intestinal transplantation has taken a backseat, mainly because of its higher rejection rates. Despite this, experimental models tend to focus on intestinal transplantation or isolated liver transplantation, likely because of the technical complexity of MVT. This study aimed to outline a refined surgical protocol for MVT in rats. Materials and Methods:Syngeneic heterotopic MVT was performed in five Sprague-Dawley rat under sevoflurane anesthesia. The grafts included liver, stomach, pancreas, and small bowel tissues. These were anastomosed en bloc, end-to-end, to the infrarenal vena cava and aorta. Results:A 100% survival rate was achieved. Initially, the clinical discomfort scores increased during the first 48 h but gradually improved by days 6-7, coinciding with weight recovery and normalization of behavior. Histological analysis revealed preserved architecture of the stomach, pancreas, and native organs. The intestinal tissue remained largely unchanged, with mild villous tip edema noted in one case. One grafted liver showed necrosis and hemorrhage, whereas the remaining grafts were viable, with mild congestion in two cases. Biochemical analyses revealed normal levels of total bilirubin, gamma-glutamyl transpeptidase, lipase, urea, and creatinine. Aspartate transaminase, alanine transaminase, alkaline phosphatase, and lactate dehydrogenase levels were elevated, but none reached statistical significance when compared with the pre-transplant values. Conclusions:This model offers a dependable and reproducible platform for experimental MVT, providing a well-documented and accessible tool to encourage the incorporation of MVT into current translational and immunological research.
Background:Mixed-oil (MO) intravenous lipid emulsions (ILEs) are increasingly used in adults receiving home parenteral nutrition (HPN), but prospective data from United States HPN programs remain limited. This feasibility pilot trial randomized adults newly initiated on HPN to MO versus soybean-oil (SO) ILE. The prespecified primary endpoint was change in total bilirubin over 12 weeks; secondary endpoints included feasibility, tolerance/safety, liver enzymes, C-reactive protein (CRP), and fatty acid profile. Methods:This was a pragmatic, single-center, blinded, randomized, prospective trial of adults newly initiated on HPN and expected to require HPN for more than 3 months. Participants were randomized to SO ILE or MO ILE. The standard HPN follow-up protocol was used to assess tolerance, complications, laboratory outcomes, and fatty acid profiles at baseline and through 12 weeks. Analyses included randomized participants with available data at each time point. Results:Twenty-two participants were randomized (SO ILE n = 11; MO ILE n = 11). Groups were similar in baseline demographic and PN macronutrient characteristics, and all participants had normal baseline liver enzymes and bilirubin. Total bilirubin, the primary endpoint, did not differ significantly between groups at weeks 4, 8, or 12 (week 12 median change 0 [IQR -0.1, 0.1] in SO ILE vs 0 [0, 0.1] in MO ILE; p = 0.96). No significant between-group differences were observed in liver enzymes or CRP. MO ILE was associated with significant increases in EPA and DHA by week 4 that were maintained through week 12, whereas SO ILE was not. Conclusion:In this feasibility pilot study, MO ILE was tolerated in United States adults newly initiated on HPN and produced the expected increase in EPA and DHA, with potential benefit in reduction of inflammation in the setting of inflammatory insult. Further multi-center trials are needed to confirm these findings and explore long-term outcomes.
Background To explore and compare practices of European Intestinal Rehabilitation Centres participating in the European Reference Network for rare Inherited and Congenital Anomalies (ERNICA) intestinal failure (IF) working group when weaning short bowel syndrome (SBS)-IF infants from parenteral nutrition (PN). Material and methods Questionnaires were distributed by email to 49 ERNICA centres. Details regarding oral/nasogastric (NG) feeding when weaning PN, use of protocols/guidelines, criteria for PN cycling/reducing infusion hours, dietary recommendations, use of synthetic glucagon-like peptide-2 (teduglutide), antibiotics for intestinal bacterial overgrowth and long-term follow-up practices were requested in children with neonatal onset SBS-IF. Descriptive statistical analysis was conducted. Results Thirty-five/49centers from 15 countries participated. In non-thriving infants aged < 6months, 74.3% centres supplemented oral intake with NG feeding and 94.3% continued it for > 6months if needed. Local/national guidelines were used by 63% when weaning PN. Criteria for cycling PN included age (range: term-3 months), weight (3–4.5 kg), and enteral feed tolerance with 95% centres reducing PN infusion rate before disconnecting. In 88.6% centres patients were monitored until transitioned to adult care (even if weaned from PN). Dietary recommendations and antibiotic usage varied widely. Teduglutide was used in 23/25(92%) centres from 11 countries where it was approved and funded. Conclusion A variety of nutritional strategies were used to wean PN in SBS-IF infants even in specialist centres using guidelines. NG-tube feeding was used alongside oral intake in most centres, but other practices differed widely. Multicentre studies investigating which practices are associated with the best outcome for infants with SBS-IF are needed to develop evidence-based guidelines.
Background:There is a shortage of clinical expertise in chronic intestinal failure (CIF). We aimed to explore patient perspectives on the need for an evidence-based virtual tele-learning program to train patients in best practice CIF care using the ECHO™ Model. Findings were used to inform development of the Patient Intestinal Failure-ECHO (PIF-ECHO) Project.Material and Methods: Using a qualitative research design, this study included interviews with six CIF patient advocates and two virtual focus groups with nine individuals living with CIF who expressed interest in PIF-ECHO. Data were coded and analyzed using iterative thematic analysis to generate themes focused on perceived need for and value of PIF-ECHO. Results:Four main themes were identified: 1) lack of provider access and support for patients living with CIF, 2) high levels of patient responsibility for disease management, self-advocacy, and system navigation, 3) limited access to patient-facing information on best practice CIF care, and, 4) severe emotional strain. Perceived value of PIF-ECHO centered on the program's potential to improve knowledge and access to resources, which participants hypothesized would lead to improved capacity for disease self-management, and ability to advocate for their needs across healthcare settings. Findings informed the development of a PIF-ECHO logic model illustrating connections between program activities and anticipated outcomes. Conclusion:A patient-facing ECHO program for CIF has the potential to address patient-identified needs related to access to specialist expertise and patient education, ultimately improving CIF patients' ability to manage their own care and advocate for their needs across systems.
Background:Health information-seeking is a central strategy used by patients and caregivers to cope with chronic illness. This study investigated the sources of disease-specific information utilized by adult patients with IF and caregivers of pediatric IF patients to identify existing information needs. Materials and methods:Using a community-driven research design, we developed a cross-sectional questionnaire to identify information sources and needs. The survey was disseminated via relevant patient support organizations, personal networks, and disease-specific social media support groups. Descriptive and univariate analyses were conducted to identify common information sources and needs and assess differences by respondent type. Results:A total of 283 respondents, consisting of adult patients with a history of IF (n = 167) and caregivers of pediatric patients with a history of IF (n = 116), completed the survey. Only half were receiving care via an intestinal rehabilitation program. The most frequently used sources of IF-specific information were specialist providers or teams (64%) and social media support groups (52%); a significantly larger share of patients than caregivers reported general practitioners as an information source (30% vs. 13%, p = 0.001). Top information needs pertained to 1) better understanding the current state of the field, 2) optimizing day-to-day life with IF and improving quality of life, and 3) supporting mental health and fostering a sense of connection. Conclusion:Within this sample of engaged and resource-seeking participants, we found respondents utilized multiple information sources and expressed a range of information needs. We offer several suggestions for addressing these needs.
Background Megacystis–microcolon–intestinal hypoperistalsis syndrome (MMIHS) is a rare congenital visceral myopathy characterized by severe gastrointestinal dysmotility and bladder dysfunction, most commonly associated with ACTG2-mutations. Case report We report a preterm neonate with prenatally detected megacystis and a de novo heterozygous ACTG2 variant (c.593G>T; p.Gly198Val). Postnatally, the patient developed progressive abdominal distension and feeding intolerance. Imaging demonstrated dilated bowel loops and microcolon. Exploratory laparotomy on day 5 confirmed dilated ileum, microcolon, and massive megacystis without mechanical obstruction. Gastrostomy and ileostomy were performed. The patient required parenteral nutrition followed by gradual enteral feeding with stool recirculation. Clean intermittent catheterization and antibiotic prophylaxis were initiated. Conclusion MMIHS should be suspected in cases of fetal megacystis. Early genetic diagnosis and multidisciplinary management, including intestinal failure rehabilitation and urological care, are essential to improve outcomes.
Background:Treatment strategies for intestinal failure associated liver disease (IFALD) include use of fish-oil lipid emulsion (FO-ILE) or mixed-oil emulsion containing soy, medium chain triglyceride, olive, and fish oils (SO,MCT,OO,FO-ILE). FO-ILE is limited to 1 g/kg/day, either limiting overall calorie provision or shifting calories toward carbohydrate predominance. The objective of this project was to compare the growth of neonates with IFALD receiving either SO,MCT,OO,FO-ILE or FO-ILE. Material and methods:A retrospective chart review was conducted of neonates with IFALD receiving SO,MCT,OO,FO-ILE or FO-ILE. Growth metrics, nutritional data, and lab values were analyzed using the Mann-Whitney or t-test with a p-value < 0.05 used for significance. Results:We included 46 patients (22 SO,MCT,OO,FO-ILE; 24 FO-ILE). Both groups had similar weight gain (SO,MCT,OO,FO-ILE 24.6 vs FO-ILE 31.6 g/day; p = 0.121), although the FO-ILE patients had increased weight z-scores over time (SO,MCT,OO,FO-ILE: -0.11 vs FO-ILE: 0.09 p = 0.032). The FO-ILE group received fewer calories (SO,MCT,OO,FO-ILE:112 vs FO-ILE:100.7 kcal/kg/day; p = 0.004), less lipid (SO,MCT,OO,FO-ILE: 2.1 vs FO-ILE 1.0 g/kg/day; p < 0.001), and more carbohydrate (SO,MCT,OO,FO-ILE: 9.6 vs FO-ILE: 12.8 mg/kg/min; p < 0.001). Conclusion:Neonates receiving FO-ILE had similar weight gain to those receiving SO,MCT,OO,FO-ILE while receiving fewer overall calories and parenteral lipid. The FO-ILE group did have increased weight z-score over time. Further investigation is needed to understand the influence of these differences on additional short-term and long-term outcomes.
Background Sensitized candidates for isolated intestinal or modified multivisceral transplantation (MMVT) face prolonged wait times and higher rejection risk from donor-specific antibodies (DSA). While desensitization is established in kidney transplantation, data in intestine/MMVT are limited. Case report Three adults with cPRA ≥ 95% underwent desensitization with Rituximab, plasma exchange, and monthly infusions of IgG, guided by C1q DSA testing. All three patients were transplanted—two with negative crossmatches and one despite a positive B-cell crossmatch given C1q-negative DSAs. No early AMR occurred; one developed mild acute cellular rejection, responsive to therapy. Infectious complications were common but manageable. Outcomes varied: one died nearly four years post-transplant from non-adherence leading to infections and severe rejection, one succumbed to necrotizing fasciitis at 10 months with a functional graft, and one remains alive with excellent graft function. Conclusion C1q-guided desensitization enabled successful transplantation in highly sensitized isolated intestine/MMVT recipients, supporting its feasibility. Further clinical studies are warranted.
Adequate absorption of nutrients, fluids, and electrolytes is essential for maintaining physiological function and overall health. Clinical evaluation of the intestinal absorptive capacity is therefore important for diagnosing and managing chronic gastrointestinal disorders with impaired nutrient absorption. To this end, metabolic balance studies (MBS), which assess the intestinal absorption of energy, macronutrients, fluids and electrolytes, are considered the gold standard. However, full MBS are performed in only a few specialized centers due to their complexity and high resource demands. This paper provides a detailed methodological practice guide to conducting MBS, covering the entire process from standardized sample collection to laboratory procedures such as homogenization and freeze-drying, followed by quantitative analysis of energy, fat, carbohydrates, protein (nitrogen content), wet weight, and electrolytes. By offering a clear and reproducible framework, the aim of this guide is to support the broader implementation of MBS as an objective tool for assessing digestive and absorptive capacity in patients with malabsorption.
Background:Guidance on the optimum nutritional management of patients receiving intestinal transplants (ITx) is limited. We aimed to i) describe the nutritional management of adult ITx patients in the immediate post-ITx period and ii) examine nutritional status using BMI across the ITx journey. Methods:A retrospective analysis included all adult-recipients of an intestine-containing graft at Addenbrooke's Hospital, Cambridge between 2007 and 2024. Data collected included nutritional routes immediately post-ITx (parenteral nutrition-PN, enteral nutrition-EN and oral feeding-OF) and BMI at ITx and 1 yr post-ITx. Associations between baseline BMI (at-ITx) and 1 yr post-transplant (1yr-ITx) were examined using logistic-regression for the risk of being overweight-obese at 1yr-Tx (BMI:<25 vs. ≥25 kg/m2). Results:166 patients (median age 45 yrs (IQR: 34-53), and 49% female) were included in the study. Duration of PN, EN, and time to OF post-ITx was 24 days (IQR: 14-35); 38days (IQR: 15-82), 13 days (IQR: 9-24), respectively. Median weight loss 3 months post-ITx was 9% of Tx-weight, reducing to 2% at 6 months. In logistic-regression, baseline-BMI (<25 kg/m2 vs. ≥25 kg/m2) predicted 1yr-BMI (<25 kg/m2 vs. ≥25 kg/m2) [OR:4.9, 95%CI:1.88-12.77], in adjusted analyses. 24% patients with a healthy baseline-BMI became overweight or obese at 1yr-Tx (P < 0.0001). Conclusion:Our study shows that i) weight loss occurs within the first 3 months post-ITx, though mostly re-gained within 6months; ii) post-MVTx oral diet is initiated by 2 weeks; and iii) baseline BMI is the only significant predictor of 1 yr post-ITx BMI. However, 1 in 4 ITx patients with a healthy baseline BMI were observed to become overweight or obese at 1 yr. Further research is required to elucidate what mechanisms lead to the development of obesity after transplant.
Background Accurate assessment of energy requirements is essential for patients with intestinal failure (IF) to avoid complications associated with parenteral nutrition. Predictive equations are commonly used in clinical practice to estimate resting energy expenditure (REE), however, evidence supporting their accuracy in IF patients is limited. Indirect calorimetry (IC) is the gold standard for measuring REE but is not routinely available. This study evaluated the agreement between routinely used predictive methods in the UK and IC-measured REE in patients with IF. Material and methods A service evaluation was conducted at a tertiary IF centre. Adult inpatients with IF had REE estimated using predictive equations based on PENG and ESPEN guidance, followed by IC measurement. Agreement between predicted and measured REE was assessed using mean bias, Bland-Altman analysis, and proportion of estimates within ±10% of IC values. Associations between prediction accuracy and IF aetiology, age, sex, and body mass index (BMI) were explored using ANOVA/linear regression. Results and conclusion Indirect calorimetry was performed in 91 patients (mean age 55 ± 17.4 years, mean BMI 21.6 ± 5.8 kg/m2). Mean measured REE was 1449 ± 297 kcal/day. Predictive equations showed poor agreement with IC at an individual level, with wide limits of agreement. Mean bias was + 18.6 kcal/day (-585 to +622 kcal/day) for PENG and + 94.9 kcal/day (-620 to +809 kcal/day) for ESPEN. Only 33.7 (PENG) and 30.4% (ESPEN) of estimates were within ±10% of measured REE. Predictive equations are inaccurate in IF patients, supporting routine use of IC to enable precise, individualised energy prescription.
Background Thiamine deficiency is a rare but life-threatening complication for which children on long term parenteral nutrition (PN) are at higher risk. Case report We describe a 13-year-old male with intestinal failure secondary to Filamin A mutation who presented with one-week of oedema and orthopnoea. He was fully dependent on PN and his intravenous multivitamin supplementation was replaced with enteral vitamins due to a national shortage. On presentation he was tachycardic, tachypnoeic, hypotensive, and fluid overloaded. Investigations revealed hyponatraemia, hypoalbuminaemia, metabolic acidosis, and a significantly elevated lactate. Chest radiography showed bilateral pleural effusions. Intravenous thiamine and oral vitamin C supplementation led to rapid clinical improvement and testing confirmed low thiamine and vitamin C levels. His presentation was consistent with wet beriberi due to thiamine deficiency. Conclusion This case highlights the risk of water-soluble vitamin deficiency in PN-dependent children during intravenous vitamin shortages and the need for biochemical monitoring.
Introduction As global awareness of environmental challenges grows, integrating sustainability into clinical nutrition practices is essential to support both human and planetary health. Within healthcare systems internationally there are a number of barriers to enhanced sustainability which need to be understood, in order for them to be overcome. Method A bespoke questionnaire-based survey was developed and disseminated internationally to healthcare professionals working in the sphere of clinical nutrition. Quantitative and qualitative analysis was performed on the recorded responses. Included within the survey was the Sustainability Attitudes Scale (SAS). Results A total of 126 responses were collated from 18 countries worldwide. Dietitians comprised the largest represented profession with 35%, followed by doctors 32%. There was a strong opinion that sustainability in a very important aspect of respondents considerations, both in and outside of their working lives. 99% stated they would be in support of changes aimed at making their clinical practice less harmful to the environment. 87% stated that they had never received any formal training in improving sustainability, with a lack of knowledge or experience being recognized as a significant barrier to sustainability focused working practices. 4% stated that it would not be acceptable to consider bearing the potential higher financial cost. Conclusion The findings highlight a clear enthusiasm among clinical nutrition professionals for integrating sustainability into practice, despite widespread gaps in formal training and knowledge. Addressing these educational and systemic barriers is crucial to empowering healthcare providers to adopt environmentally responsible approaches.
Introduction:Pediatric residents at our institution manage patients with intestinal failure (IF), but report associated anxiety due to clinical inexperience and lack of formal education in this field. This pilot project aimed to identify knowledge gaps and address them through a targeted educational intervention. Methods:A needs assessment survey was distributed to all pediatric residents via QR codes and email. The survey included Likert-scale, multiple-choice, open-ended, and rating questions to assess confidence in IF-related care. Survey results informed a targeted curriculum that addressed key deficit areas through an in-person lecture, workshops, and a reference guide aligned with residents' preferred learning formats. A post-intervention survey, modeled after the initial assessment, was distributed five months later to evaluate the curriculum's impact. Results:Of the 131 residents, 40 (31%) completed the initial survey. Residents reported lowest confidence (<4/10) in calculating and ordering home Total Parenteral Nutrition (TPN) and TPN-like fluids, understanding remaining anatomy, managing central access loss and poor catheter blood flow, identifying signs of D-lactic acidosis and small intestinal bacterial overgrowth (SIBO), and ensuring proper stoma care. Conversely, they felt more confident managing feeding intolerance and central line-associated infections (5-6/10), and signs of shock (>7/10). Five months post-implementation, twenty residents (15%) completed the post-intervention survey, showing improved confidence in managing IF patients, particularly in TPN management (p = 0.0083) and enteral/stoma care (p = 0.0393). Interest in IF education increased from 64% to 85%. Conclusion:The needs assessment highlighted critical gaps in resident IF education. A targeted, resident-informed curriculum improved confidence and engagement. Next step is national dissemination.
Intestinal Failure-Associated Liver Disease (IFALD) presents significant challenges in pediatric patients on long-term parenteral nutrition (PN). Case report We conducted a case series to evaluate safety and efficacy of administering higher dose (2 g/kg/day) Omegaven® (Fresenius Kabi AG, Bad Homburg, Germany), a fish oil-based lipid emulsion (FOLE), in pediatric patients with IFALD. Ten patients at Boston Children’s Hospital were found to have received FOLE at 2 g/kg/day. Data was retrospectively collected from electronic health records, including demographics, laboratory values, and treatment outcomes. Conclusion All patients using higher dose FOLE successfully transitioned to 20-hour PN cycles with FOLE 2 g/kg/day, meeting daily caloric requirements and preventing hypoglycemia. No adverse reactions were reported. For most patients, liver function markers remained within normal limits. Our findings suggest higher dose FOLE can facilitate PN cycling and promote growth. Further studies are warranted to validate these findings and establish optimal dosing for this patient population.
Background Pediatric survival rates in intestinal failure (IF) and transplant (ITx) have improved over time. However, surgery and prolonged hospitalization can impact motor function and levels of physical activity (PA), which is an essential health behaviour for physical, social, and mental health. This position paper provides clinical recommendations to optimize PA, strength, and exercise in children with IF and ITx. Methods A working group of the IIRTA Allied Health committee conducted a literature review, identifying relevant articles between 2000 and 2023. Key recommendations were based on scientific evidence and expert-informed opinion. Results Research indicates children with IF have altered body composition and lower physical function, PA, and muscle strength compared to healthy peers. They also have a higher prevalence of motor delays and an increased risk of sarcopenia pre-and post-ITx. Although exercise can potentially improve these outcomes, parents report unique barriers to PA including central lines and medical appliances. Key recommendations include:1) Early intervention with rehabilitation specialists in hospital and on discharge to the community.2) Education related to PA guidelines including aerobic intensity and strengthening activities.3) Provision of individualized exercise plans with communication and support in school/community settings.4) Ongoing screening at out-patient visits to monitor body composition, strength, and PA and address potential barriers and safety issues.5) Prioritizing multi-center research on PA benefits and effective interventions. Conclusions This position paper offers actionable steps to optimize physical function, PA, and exercise, and highlights the need for research on exercise efficacy, safety, and intervention in this population.
Background:Renal impairment is common in patients receiving long-term home parenteral nutrition (HPN) for short bowel syndrome-associated intestinal failure (SBS-IF). While glucagon-like peptide-2 (GLP-2) analogues like teduglutide are effective in reducing parenteral support (PS) requirements, data on their use in advanced stage chronic kidney disease (CKD) or haemodialysis are scarce. Case report:We describe a 66-year-old female with SBS-IF on HPN, complicated by hyperoxaluria and nephrocalcinosis contributing to stage 4 CKD. Initial renally-adjusted teduglutide dosing (0.025 mg/kg/day) enabled enteral autonomy, but was interrupted by intercurrent illness. As a result of progressive renal dysfunction, the patient was commenced on haemodialysis. Teduglutide was introduced post-dialysis at full dose (0.05 mg/kg), resulting in a sustained 36 % reduction in weekly PS requirements without adverse effects, despite recurrent sepsis. Conclusion:This case demonstrates a clinically significant teduglutide response in a haemodialysis-dependent SBS-IF patient, supporting post-dialysis dosing as a feasible strategy in this HPN cohort.
Objective Studies investigating growth impairment (GI) in children with intestinal failure (IF) have seldom reported its associated factors. We hypothesized that a deficient nutritional intake would affect GI in children with IF. Methods Nineteen patients (2–16 years old) who underwent home-based parenteral nutrition (PN) management at our institution, were divided into patients with or without GI (GI+/GI–). GI was defined as a height-for-age z-score (HAZ) ≤ −2. We performed between-group comparisons of HAZ in the intestinal rehabilitation program (IRP)/nutrition support team (NST) introduction time, PN dependency, residual small intestine length (RSIL), nutritional intake (calorie, protein, lipids, and carbohydrates), caloric intake ratio, and nutrient intake as a percentage of the recommended intake. Results Six patients were in the GI+ group. PN dependency was significantly higher in the GI+ group (GI+, 109.8 %; GI < median, 61.7 %, P = 0.036). RSIL did not differ significantly between the groups (50 cm vs. 45 cm, P = 0.879). In the GI+ group, the caloric percentage of lipids was significantly lower (11.9 % vs. 17.5 %, P = 0.002), but that for carbohydrates was significantly higher (76.8 % vs. 66.8 %, P = 0.002), while lipid sufficiency was significantly lower (37.5 % vs. 89.6 %, respectively; P < 0.001). Protein intake in the GI+ group was significantly lower; however, the corresponding sufficiency was > 100 % in both groups (136.5 % vs. 209.2 %, P = 0.005). Conclusion For children with IF, a low intake ratio of proteins and lipids relative to energy requirement and required nutrient levels may inhibit adequate growth.
Background:A new role within an intestinal failure unit was devised, which involved training a dietitian to undertake the role of an Advanced Practitioner working within the medical team. In the United Kingdom, dietitians can only undertake supplementary prescribing qualifications, and this study evaluates the safety and effectiveness of this type of prescribing practice in an intestinal failure Advanced Practitioner role. Materials and methods:All adult inpatients with types 2 and 3 intestinal failure were included. An appropriate clinical management plan was agreed by the multidisciplinary team and a medical and surgical consultant reviewed the prescriptions made, including the clinical indication and rationale. Descriptive statistical analysis was used and data presented as means (+/- standard deviation) for continuous variables and percentages for categorical variables. Results:A total of 1030 prescription episodes were made by the supplementary prescriber in the 6-month study period. Of these episodes, 96.2 % (n = 991) related to parenteral or intravenous fluid prescriptions; 13.6 % (n = 135) of which related to a combination of parenteral support and intravenous fluid prescriptions and 0.2 % (n = 2) of these episodes were for resuscitation purposes. No prescription amendments were required following a weekly review by the medical or surgical consultant. Conclusion:This study demonstrates that a dietetic-based Advanced Practitioner in a busy intestinal failure unit effectively and safely incorporated supplementary prescribing into their role. Supplementary prescribing was used to initiate a range of prescriptions, as part of a clinical management plan, and all were deemed to be the optimal prescription choice for the indication identified.
