Malnourished patients

Since late 2009 the task force has been in charge of 469 patients of whom 2 have been treated for more than 16 years. Another 31 have been under the treatment for more than 10 years.

Artificial Nutrition (AN) to these patients, who need to recover and then maintain the nutritional balance, is useful when the normal feeding is not sufficient or is impossible.

Most of these patients have the problem of dysphagia or a lack of coordination of the swallowing. When food and fluids are ingested they invade the airway which will cause choking. The patient consequently develops a coughing fit. AN is also used on patients with tumors. Those tumors (of the head and neck, cancers of the stomach and pancreas) prevent the transit of food or affect the function of the intestines (stomach cancer, peritoneal carcinomatosis). AN is also used in patients with anorexia and in the preparation for surgery or in the treatment of surgical complications.

In these patients, the AN is evidently very important as it prevents their illness to lead to severe malnutrition that in turn almost always is the cause of an inauspicious prognosis.

The patients attending the Operative Unit are fully covered by a regional law (RD 7872/94) of which Professor Cappello was the promoter together with the subsequent amendments, which guarantee to everyone the free supply of all materials needed for Artificial Nutrition . The patient should be taken into care by the Unit. After which it becomes the responsibility of the ASL( local health care) to provide all that is necessary. This provision is valid for the region of Lazio, but other regions have developed similar laws.

It's important that the patient comes for his/her first assessment at the clinic (Building Bassotto) and is subjected to a bioimpedance meter, which is an assessment of the extent of the nutritional damage. They must then attend a preparatory course of 3 hours which is held every Saturday, at the Bassotto Building, from 9 am to 12 am. After that, the patients will receive all the materials needed to start the treatment.

How much does it cost?

Domiciliary Artificial Nutrition in malnourished patients is a benefit provided by the National Health Service.

For outpatient visits, a referral from a GP is needed requesting a "Surgical visit” (16 Euros). And for "Bioimpendance” (12 Euros).

Based on the regulation of the Lazio Region, home treatment should be completely free of charge. That includes:
> Nutritional solutions
> Pumps
> Sterile bags
> Blood Glucose tests
The patient should go regularly to his/her local health care centre to collect his/her equipment to be used at home and then follow the instructions of Prof.Cappello contacting by phone the AN Service on a regular basis.

In reality, however, some medications, that are essential for the routine management of the treatment (drugs to inhibit gastric acid secretion and drugs to control the channeling of the intestine), are not provided by some regional ASLs who choose to interpret the law in a restrictive manner. However, these drugs, which the patient will have to buy, do not have an excessive cost.