A handbook of parenteral nutrition

A handbook of parenteral nutrition

CLINICALNUTRlTION(1959)9: 0 Longman Group UK Ltd 1990 351-352 Book Reviews A HANDBOOK OF PARENTERAL NUTRITION H. A. Lee and G. Venkat Raman Chapm...

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CLINICALNUTRlTION(1959)9: 0 Longman Group UK Ltd 1990


Book Reviews A HANDBOOK



H. A. Lee and G. Venkat Raman Chapman & Hall This is a multi-author paperback book with covers the specialised topic of both hospital and home parenteral nutrition. The editors, from Southampton, are wellknown in this field and have aimed the book at a wide medical and paramedical audience. The book is intended to provide simple guidelines for its readers. Adult and paediatric parenterai nutrition together with the nursing aspects of nutritional support are covered. The nine chapters are each written by one of the editors or by one of their three co-authors. Although this allows the various aspects of parenteral nutrition to be discussed by an expert in the field, it gives rise to a problem common to multi-authorship, that of repetition. Trace element deficiencies, for example, are detailed in three chapters, and the authors differ on certain of the recommended adult daily requirements. The book does not pretend to provide a comprehensive state-of-the-art review of parenteral nutrition. Unfortunately, the text is not referenced so that readers will find it difficult to follow-up topics which interest them. A brief reading list is provided at the end of the book, as well as, rather peculiarly, a separate list at the end of the paediatric chapter. Neither list is specific enough to allow, for example, further information of the role of aflatoxins in malnutrition to be pursued (p. 20), and the paediatric list fails to provide titles for most of its references. A small number of line drawings are used to illustrate vascular access techniques in children. These are useful, but it is a pity that they were not referred to in the adult access section, where they would have greatly clarified the textual descriptions. Again, unfortunately, there is considerable duplication in these sections, as well as several important omissions or errors. No warning is given against catheter withdrawal when using a catheterthrough-needle insertion technique; it is widely recognised that catheter shearing can occur. The advice to site a feeding catheter tip in the inferior vena cava is incorrect. Pithie and Pennington have shown that the tip must lie at the entrance to the right atrium in order to avoid venous thrombosis. A glossary of products is included at the end of the book, presumably as an aid to those setting out in clinical nutrition. It occupies less than two pages and gives so little information as to be useless. A guide to vascular catheters follows which fails to include devices mentioned in the main text. Readers who are hoping to use the book as a guide to clinical practice will find difficulty with what in the

advertising industry are called ‘weasel’ words. A catheter is required to be ‘somewhat rigid’; phosphorus contributes to bone structure ‘to a great extent’; venous thrombosis may ‘set in’ around a catheter. Many things are ‘worth remembering’ or ‘worth mentioning’ or ‘worth being aware of. None of this adds to the book, nor makes it more readable. This, together with the duplications, should have been weeded out. The book has the feel of nine papers being written in isolation with little or no co-operation between the writers. It is hard to know to whom this book should be recommended. It is too detailed for the average reader, particularly those in the paramedical professions; and not detailed enough for those wanting solid clinical guidelines. The chapters on paediatric parenteral nutrition and on the nursing aspects of nutrition stand on their own, but these 57 pages are not enough to justify buying the whole book. A. Rich



J. L. Rombeau, M. D. Caldwell, L. Forlaw and P. A. Guenter The recognition that malnutrition is common in hospital practice and contributes substantially to patient morbidity prompted the development of techniques of nutritional support, by parenteral and enteral nutrition, which have become progressively refined over the last decade. These methods are now required across a wide spectrum of clinical practice. Great benefit may be derived from their careful application, inappropriate use is wasteful and careless application hazardous. Against this background the Atlas of Nutritional Support Techniques is a most useful practical guide which has been produced by a very experienced team of surgeons, physicians, nurses, pharmacists and dietitians. There are four sections which summarise in note form the methods of nutritional assessment, enteral nutrition, parenteral nutrition, and the surgical techniques for morbid obesity. The first section includes the methods of anthropometric assessment and metabolic assessment as well as useful appendices which provide information about micronutrients, minerals and biochemical parameters. The section on enteral nutrition is comprehensive, nasogastric gastrostomy and jujunostomy feeding are covered along with the specific problems of home treatment. Parenteral nutrition covers peripheral vein feeding, central catheter types insertion and care, complications