Management of the Home Parenteral Nutrition Patient

Abstract

Parenteral nutrition (PN) support can be managed in the home setting for both a short-term and long-term period or for a lifetime, permitting individuals who cannot adequately absorb nutrients enterally to achieve a normal lifestyle. Nutrition support professionals must be aware of home PN (HPN) management principles before discharge to ensure a smooth transition to home with all requisite monitoring. This article will discuss the initiation and monitoring of patients on HPN, the prevention and treatment of potential complications, the contributions of the home infusion provider, and the home nutrition support team and the outcomes of HPN.

Central Venous Access in the Home Parenteral Nutrition Population–You PICC

“…In other less desirable situations, CV catheters were placed into the internal jugular vein or the femoral vein, although catheter outcomes with these alternative venous access sites for HPN delivery are reported to incur greater complications, such as dislodgment and sepsis. 4 More recently, CV access has been obtained by peripherally inserted central catheters (PICC; Figure 3). The use of PICC dates back to the early 1900s when physicians in Berlin published their experience with a ureteral catheter passed into the antecubital vein.…”

Navigating Reimbursement for Home Parenteral Nutrition

“…The number of patients currently receiving HPN is unknown. Data in 2002 estimated there were 39,000 HPN patients 1 . The American Society for Parenteral and Enteral Nutrition's (A.S.P.E.N.)…”

“…Data in 2002 estimated there were 39,000 HPN patients. 1 The American Society for Parenteral and Enteral Nutrition's (A.S.P.E.N.) National Patient Registry for Nutrition Care (Sustain™) will assist in determining the current number of HPN patients in the United States and their insurance coverage.…”

Development of Sustain™

“…These criteria include documentation that the patient's gastrointestinal (GI) tract is nonfunctional; the condition is permanent, requiring at least 90 days of treatment; and the patient is unable to tolerate enteral feeding (eg, presence of malabsorption or obstruction) 15 . To receive HPN, patients generally use the services of a home infusion care company that provides nursing, pharmacy, and dietetic services, along with durable medical equipment 16 …”

“…Medicare, the largest payer for HPN and EN, does not generate specific public access reports on this patient population. The most recent published data from 2002 estimated that 39,000 people received HPN 16 . This estimate was based on home care infusion therapy databases and did not represent the entire U.S. population 20 .…”