ESPEN Guidelines on Parenteral Nutrition: Home Parenteral Nutrition (HPN) in adult patients

Staun, Michael; Pironi, Loris; Bozzetti, Federico; Baxter, J.; Forbes, Alastair; Joly, F.; Jeppesen, Palle Bekker; Moreno, José Manuel; Hébuterne, Xavier; Pertkiewicz, M.; Mühlebach, Stefan; Shenkin, Alan; Gossum, A. Van

doi:10.1016/j.clnu.2009.04.001

Cited by 350 publications

(374 citation statements)

References 108 publications

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“…153 Other factors demonstrating statistically significant effects on QoL include narcotic use, oral fluid volumes, nocturia, the presence of a stoma, age and the number of infusions required per week. 16,56,154,155 Thus, any reduction in the latter that may be afforded by the use of trophic factors will be welcomed.…”

Section: Outcome Of Long-term Pnmentioning

confidence: 99%

“…16 CVCs are usually placed using the Seldinger technique, positioning the catheter tip between the lower third of the superior vena cava and the atrio-caval junction, a site that is associated with a lower incidence of venous thrombosis (P 0.0005).…”

Section: Vascular Accessmentioning

confidence: 99%

“…The primary energy source in PN formulations can be derived either from a combined carbohydrate and fat emulsion administered together or from separate glucose and fat PN formulations administered on different days. 16 Lipid emulsions were initially from soybean oil, which contains relatively high levels of omega-6 essential fatty acids and may be associated with hepatotoxicity (see below). 17 Newer preparations containing long and medium chain triglycerides with a more physiological balance of omega 3 and 6 fatty acids have since been created.…”

Section: Parenteral Nutrition Formulationsmentioning

confidence: 99%

“…The choice between tunnelled lines and ports will be determined by patient choice and nursing staff experience: ports will certainly be less attractive if the patient requires frequent access due to the repeated skin puncture required. 16 Peripherally inserted central venous catheters (PICCs) and peripheral midline catheters are also used for PN administration, but the higher risk of displacement and/ or thrombosis inherent to these lines usually limits their use to 2-3 months. 34,35 Furthermore, PICC lines also tend to be unsuitable for long-term HPN as patients find them difficult to self-access as they are sited in the anticubital fossa or upper arm.…”

mentioning

confidence: 99%

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Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

136

108

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SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

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Section: Outcome Of Long-term Pnmentioning

confidence: 99%

Section: Vascular Accessmentioning

confidence: 99%

Section: Parenteral Nutrition Formulationsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

136

108

View full text Add to dashboard Cite

show abstract

“…They should be motivated to administer it properly, adapt their lifestyle accordingly and have an appropriate home environment in which to give PN. 15 Small bowel length determines need for long-term nutrition and fluid. It is achievable with just 50 cm of jejunum, parenteral requirement may be for saline alone and if the colon is present the oral and or enteral route may be successful.…”

Section: Provision Of Parenteral Nutritionmentioning

confidence: 99%