Changes in Home Parenteral Nutrition Practice Based on the Canadian Home Parenteral Nutrition Patient Registry

Hortêncio, Taís Daiene Russo; Arendt, Bianca M.; Teterina, Anastasia; Jeejeebhoy, Khursheed N.; Gramlich, Leah; Whittaker, J. S.; Armstrong, David; Raman, Maitreyi; Nogueira, Roberto José Negrão; Allard, Johane P.

doi:10.1177/0148607115609289

Cited by 38 publications

(37 citation statements)

References 29 publications

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“…Recommendation 10A: HPN plays a well‐established role in the treatment of adults and children with intestinal failure 1 , 2 . HPN is indicated for clinically stable patients who cannot completely meet their nutrition requirements through oral intake or EN due to compromised digestion or absorption of nutrients 3 , 4 . Many HPN recipients depend on daily PN infusions, but for those with less severe gastrointestinal impairment, PN takes on a more supplemental role that allows some PN‐free days.…”

Section: Question 10: Which Patients Are Appropriate For Home Pn Thermentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

164

196

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Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings. (JPEN J Parenter Enteral Nutr. 2017;41:324-377) The etiology-based nutrition diagnoses in adults in clinical practice settings are as follows: Starvation-related malnutrition: Chronic starvation without inflammation (eg, anorexia nervosa). Chronic disease-related malnutrition: Inflammation is chronicand of mild to moderate degree (eg, organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity). Acute disease or injury-related malnutrition:Inflammation is acute and of severe degree (eg, major infection burns, trauma, closed head injury). 2,3Malnutrition, pediatric: An imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. It is recommended that growth charts based on a standard deviation z score system be used to track and assess nutrition status in children. 4,5Nutritionally-at-risk: Consider the individual nutritionally-atrisk if any of the following is present. Nutritionally-At-Risk Adult Summary of RecommendationsThese consensus recommendations are designed to identify best practices, guide day-to-day clinical decisions, reduce variations in practice, and enhance patient safety. They are not intended to supersede the judgment of the healthcare professional based on the circumstances of the individual patient.

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Section: Question 10: Which Patients Are Appropriate For Home Pn Thermentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

164

196

View full text Add to dashboard Cite

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“…Meanwhile, cancer is the dominant indication for HPN in the United States and Japan, making up approximately 40% of the HPN population in these countries [3]. In Canada, more than 90% of HPN use is in the context of SBS (32%), cancer (38%), and surgical complications (30%) [35]. …”

Section: Home Parenteral Nutritionmentioning

confidence: 99%

“…The database has also been used to study changes in HPN practice and demography [35]. In Canada, these studies have led to improvements in clinical practice and outcomes, such as reducing the incidence of central line infection [35], with workshops reviewing data from HPN programs organized during the Canadian Nutrition Society annual meetings. Therefore, in rare diseases such as SBS and HPN, a registry is very useful to track patients and improve management.…”

Section: Home Parenteral Nutritionmentioning

confidence: 99%

Parenteral Nutrition and Intestinal Failure

Bielawska

Allard

2017

Nutrients

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Severe short bowel syndrome (SBS) is a major cause of chronic (Type 3) intestinal failure (IF) where structural and functional changes contribute to malabsorption and risk of micronutrient deficiencies. Chronic IF may be reversible, depending on anatomy and intestinal adaptation, but most patients require long-term nutritional support, generally in the form of parenteral nutrition (PN). SBS management begins with dietary changes and pharmacologic therapies taking into account individual anatomy and physiology, but these are rarely sufficient to avoid PN. New hormonal therapies targeting intestinal adaptation hold promise. Surgical options for SBS including intestinal transplant are available, but have significant limitations. Home PN (HPN) is therefore the mainstay of treatment for severe SBS. HPN involves chronic administration of macronutrients, micronutrients, fluid, and electrolytes via central venous access in the patient’s home. HPN requires careful clinical and biochemical monitoring. Main complications of HPN are related to venous access (infection, thrombosis) and metabolic complications including intestinal failure associated liver disease (IFALD). Although HPN significantly impacts quality of life, outcomes are generally good and survival is mostly determined by the underlying disease. As chronic intestinal failure is a rare disease, registries are a promising strategy for studying HPN patients to improve outcomes.

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“…Sin embargo, fueron los que tuvieron más complicaciones sépticas relacionadas con el catéter. En Canadá se documentaron 1,58 sepsis/1.000 días relacionadas con el catéter de 2005 a 2008 y 0,97/1.000 días de NPD entre 2011 y 2014 (17,18); en otra serie europea Guglielmi y cols. (20) registraron 1,40 sepsis por catéter/1.000 días de NPD con mayor incidencia en pacientes oncológicos.…”

Section: Discussionunclassified

Nutrición parenteral domiciliaria en los pacientes oncológicos

et al. 2017

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Objetivo: analizar las características de los pacientes oncológicos con nutrición parenteral domiciliaria (NPD) recogidos en el registro NADYA.Método: estudio transversal de los datos recogidos en el registro del grupo de nutrición artificial domiciliaria y ambulatoria NADYA de pacientes con NPD y diagnóstico oncológico explicito, desde el 1 de enero de 2010 al 31 de diciembre de 2016.Resultados: en los 7 años estudiados se han recogido 1463 pacientes, de los que 599 han tenido un diagnóstico de cáncer (40,94%) con un incremento del 43% desde el inicio. La edad media fue de 57 años IIQ [46 – 64] registrándose 5 niños. La mayoría de los pacientes eran oncológicos paliativos (51,3%). Se registraron 3,18 complicaciones sépticas relacionadas con el catéter por cada 1000 días de nutrición, con mayor frecuencia en el grupo de enteritis rádica (ANOVA p<0,001). La principal causa de finalización fue el fallecimiento 61%, los pacientes paliativos en mayor proporción que los demás diagnósticos (x2 = 53.819; p<0,001).Conclusiones: los paliativos representan la mayoría de los pacientes oncológicos con NPD, siendo la obstrucción intestinal y el síndrome de intestino corto los motivos de indicación de casi el 80% de los casos. Los pacientes con enteritis rádica han sido los que menos complicaciones metabólicas y sépticas no relacionadas con el catéter presentaron, siendo los que más complicaciones sépticas relacionadas con el catéter. La calidad de vida sería un parámetro que proporcionaría una información muy valiosa en estos pacientes, siendo una limitación de este estudio no disponer de datos al respecto.

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Changes in Home Parenteral Nutrition Practice Based on the Canadian Home Parenteral Nutrition Patient Registry

Abstract: The Canadian HPN registry is useful in tracking trends in demography, outcomes, and clinical practice. Results suggest a shift in patient demography and line access with improvement in line sepsis, hospitalizations, and HPN prescriptions.

Cited by 38 publications

References 29 publications

When Is Parenteral Nutrition Appropriate?

When Is Parenteral Nutrition Appropriate?

Parenteral Nutrition and Intestinal Failure

Nutrición parenteral domiciliaria en los pacientes oncológicos

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