Vol 2, No 1 (2021)

This article provides an overview of the significant changes in clinical practices since the publication of the European Association for Clinical Nutrition and Metabolism guidelines on providing vascular access for parenteral nutrition regarding the choice of vascular access and prevention and treatment of the most common and important complications of long-term venous access, the catheter-associated bloodstream infection, and internal lumen obstruction of catheters.

The preferred vascular access for parenteral nutrition for medium- to long-term parenteral nutrition is the tunneled central venous catheter, peripherally inserted central catheter, or a fully implantable port system, which is now largely determined by the underlying disease, near-term prognosis and patient comfort, and short-term parenteral nutrition in a hospital that largely depends on the capabilities of a particular medical institution. Strict adherence to modern standard measures for infection control and care of venous access and infusion lines, hand hygiene, and appropriate training of medical personnel, patients, and their caregivers are currently the most reliable and effective methods to prevent catheter-associated bloodstream infection. Taurolidine “catheter lock” is used as an additional measure.

In most cases, the occlusion of the inner canal of the catheter can be eliminated by drug methods; however, its effectiveness directly depends on the correspondence of the chosen drug to the cause of the occlusion. Generally, changes in recent years have significantly reduced the incidence and risk of parenteral nutrition complications associated with vascular access.

Specialists are interested in using bioimpedance technology to assess the rate of metabolic processes and body composition; thus, this study aimed to determine the possibilities of the clinical application of the phase angle, which is a parameter that is specific for the bioimpedance method to obtain body composition information. In nutrition assessment, the phase angle is used as an indirect characteristic of the protein fraction of the body and the rate of metabolic processes.

In the early 2000s, low values of the phase angle in diseased catabolic orientation were shown to assess the survival rate whereas high values assess the muscular system fitness in athletes and other individuals who regularly experience physical exertion. Systematic reviews and Meta-analyzes of subsequent years have summarized the evidence based on these provisions and identified several new applications for sarcopenia, anorexia, and renal failure. Therefore, all the reviews presented in this study confirm that higher phase angle values correspond to a better state of the body and that phase angle can dynamically change in an individual patient. This feature of the parameter requires a detailed understanding of the variability of values depending on measurement conditions.

The phase angle is recognized as a convenient diagnostic tool and a convenient parameter for screening examinations. At high values, it reflects the degree of muscular system fitness, and at low values, the severity of catabolic disorders due to existing diseases or immobilization.

On March 12, 2021, at 62 years of age, a member of the editorial colleague of the journal “Clinical Nutrition and Metabolism”, a professor and a doctor of medical sciences — Igor Valentinovich Pryanikov — suddenly passed away.

Igor Valentinovich made an invaluable contribution to the development of intensive care and medical rehabilitation of patients with the consequences of serious diseases, injuries and lesions of the central nervous system, the organization of a state system of measures aimed at reducing disability and mortality rates in the Russian Federation.