Purpose: The purpose of this study was to predict the appropriate insertion length of a peripherally inserted central catheter (PICC) based on body measurements.

Materials and Methods: We made the following 3 measurements on body surface in 222 patients who underwent placement of a PICC under radiographic guidance between May 2016 and May 2017 : Acm, half the length of the sternum (from the center of the upper edge to the lower edge) ; Bcm, the distance from the center of the upper edge of the sternum to the head of the humerus;, and Ccm, the distance from the head of the humerus to the point of PICC insertion. Xcm denoted the sum of Acm, Bcm, and Ccm. Factors associated with PICC insertion length and body surface measurements were extracted, and stepwise multiple linear regression was applied to develop the formula for predicting PICC insertion length.

Results: The prediction formula derived was 0.63×Xcm+11.1-Ycm+Zcm (where Y = 1.99 cm when inserting the PICC in the right upper arm and 0 cm when inserting in the left upper arm ; and where Z = 0.85 cm when inserting in the brachial vein and 0 cm when inserting in the cephalic vein and basilica vein).

Conclusions: The insertion length of a PICC can be calculated using a prediction formula based on body surface measurements taken before insertion. However, it is necessary to confirm the PICC tip position on chest X-ray.

Aim: We retrospectively examined the effect of exercise therapy in dialysis patients receiving nutritional support, with a focus on the skeletal muscle mass index (SMI).

Subjects and Methods: A total of 26 outpatients on dialysis in our hospital were divided into the intervention group who received exercise therapy (n = 14, mean [SD] age 62.7 [7.55] years) and the non-intervention group who did not received exercise therapy (n = 12, mean [SD] age 66.3 [12.5] years). Both groups received daily nutritional support and dietary instruction from a registered dietitian and a nurse. Change in the SMI and the rate of such change over 6 months were examined in each group.

Results: The SMI increased significantly from 6.44 ± 0.94 kg/m² to 7.06 ± 1.00 kg/m² (p = 0.000) in the intervention group, but the change was not significant in the non-intervention group. The rate of SMI change was significantly higher in the intervention group compared with the non-intervention group (109.85 ± 7.13% vs. 99.90 ± 6.94% ; p = 0.001).

Conclusion: These results suggest that intervention involving exercise therapy and nutrition support is effective in increasing the SMI in dialysis patients.

Background: The long-term outcomes of artificial nutrition in older people with dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy (ENPEG) and total parenteral nutrition (TPN) are major methods of artificial nutrition in Japan. This study aimed to compare the long-term outcomes between ENPEG and TPN in older persons with dysphagia.

Methods: Subjects were patients who received ENPEG or TPN between January 2014 and January 2017. The primary outcome was survival time. Secondary outcomes were oral intake recovery, discharge to home, and the incidence of severe pneumonia and sepsis. We performed 1-to-1 propensity score matching using a 0.05 caliper.

Results: We identified 253 patients who received ENPEG (n=180) or TPN (n=73). Propensity score matching created 55 pairs. Survival time was significantly longer in the ENPEG group (median, 317 vs 195 days; p=0.017). The hazard ratio for ENPEG relative to TPN was 0.60 (95% confidence interval: 0.39-0.92; p=0.019). There were no significant differences between the groups in oral intake recovery and discharge to home. The incidence of severe pneumonia was significantly higher in the ENPEG group (50.9% vs 25.5%, p=0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 30.9%, p=0.018).

Conclusions: ENPEG was associated with a significantly longer survival time and a lower risk of sepsis, but also with a higher incidence of severe pneumonia compared with TPN.

Purpose: We investigated the factors associated with discharge home from convalescent rehabilitation wards.

Methods: In a retrospective cohort study of all patients discharged from convalescent rehabilitation wards between 2016 and 2018, we focused on those with stroke and hip fracture. Activities of daily living were assessed using the Functional Independence Measure (FIM) and nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF). Factors associated with discharge home were examined by logistic regression analysis.

Results: Of the total 2,184 patients discharged, 637 had a stroke (44% women; age 72 years) and 348 had hip fracture (73% women; age 78 years) . The factors associated with discharge home in stroke patients were living at home before admission (OR 10.6), FIM-motor component score at discharge (OR 1.056), and swallowing function at discharge (OR 1.4). Those associated with discharge home in hip fracture patients were living at home before admission (OR 74.7) and MNA-SF score at discharge (OR 1.516).

Conclusion: Swallowing function and nutritional status at discharge were associated with discharge home in patients with stroke and hip fracture, respectively.