Navigating the Challenges of Home Parenteral Nutrition

Koenen, Brian; Benjamin, Richard J.; Panciu, Adriana

doi:10.1002/ncp.10264

Cited by 6 publications

(8 citation statements)

References 23 publications

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“…Consistent consideration should be used in managing the transition of patients who are candidates for HPN from hospital to home care [ 20 ]. This issue is really relevant as patient’s safety always takes priority over attaining nutritional goals.…”

Section: Transition From Hospital To Home Carementioning

confidence: 99%

“…The HPN monitoring process aims at determining the appropriateness of nutritional therapy, ensuring the achievement of nutritional goals, and reducing the risk of complications [ 8 ]. Additionally, a consistent close monitoring for HPN-related complications is able in reducing unplanned hospital admissions and overall associated costs [ 20 ].…”

Section: Why Is Monitoring Important?mentioning

confidence: 99%

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Monitoring Response to Home Parenteral Nutrition in Adult Cancer Patients

et al. 2020

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Current guidelines recommend home parenteral nutrition (HPN) for cancer patients with chronic deficiencies of dietary intake or absorption when enteral nutrition is not adequate or feasible in suitable patients. HPN has been shown to slow down progressive weight loss and improve nutritional status, but limited information is available on the monitoring practice of cancer patients on HPN. Clinical management of these patients based only on nutritional status is incomplete. Moreover, some commonly used clinical parameters to monitor patients (weight loss, body weight, body mass index, and oral food intake) do not accurately reflect patient’s body composition, while bioelectrical impedance analysis (BIA) is a validated tool to properly assess nutritional status on a regular basis. Therefore, patient’s monitoring should rely on other affordable indicators such as Karnofsky Performance Status (KPS) and modified Glasgow Prognostic Score (mGPS) to also assess patient’s functional status and prognosis. Finally, catheter-related complications and quality of life represent crucial issues to be monitored over time. The purpose of this narrative review is to describe the role and relevance of monitoring cancer patients on HPN, regardless of whether they are receiving anticancer treatments. These practical tips may be clinically useful to better guide healthcare providers in the nutritional care of these patients.

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Section: Transition From Hospital To Home Carementioning

confidence: 99%

Section: Why Is Monitoring Important?mentioning

confidence: 99%

Monitoring Response to Home Parenteral Nutrition in Adult Cancer Patients

et al. 2020

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“…The previously available guidance documents address the PN process with recommendations to improve safety 1–6 . Likewise, literature addresses the use of PN for the patient at home, including patient selection, education, and clinical challenges over time 5,9–14 . The transition itself, for the PN‐dependent patient, has not been as well described with its potential pitfalls or suggestions to optimize care.…”

Section: Home Parenteral Nutritionmentioning

confidence: 99%

“…As the most common scenario, the transition from hospital to home serves as the model in this paper; however, this model and the issues addressed are translatable to equally important transitions between other sites of care. With several articles and guidance documents already describing PN therapy at home, 5,[9][10][11][12][13][14] the focus of this paper is on the aspect of safe transitions. 15,16 Any recommendations in this paper do not constitute medical or other professional advice and should not be taken as such.…”

Section: Introductionmentioning

confidence: 99%

Safe care transitions for patients receiving parenteral nutrition

Adams,

Gura,

Seres

et al. 2022

Nut in Clin Prac

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Transitions of care require coordination between inpatient healthcare providers, care managers, outpatient/ambulatory providers, and the patient/caregiver and family members. Poor communication during transitions of care can affect health outcomes and economic costs for patients/caregivers, healthcare providers, and healthcare systems. The goal of this paper is to identify risk‐prone processes in the transition of care for patients requiring parenteral nutrition (PN) between healthcare environments, including the hospital, home, skilled nursing facility, and long‐term acute care hospital settings. To facilitate the evaluation of the transition, a sequential series of steps in the transition process were identified: initial notification, assessment in preparation for transfer, identifying the receiving organization, identifying accountable providers at each sending/receiving organization, communicating the nutrition care plan, implementing the plan and additional considerations regarding PN preparation and readmissions. Safety concerns with risk‐prone processes are identified and recommended best practices are proposed for improving processes at each step of the transition. Pediatric considerations are included in the evaluation of the various steps in the transition of care. This paper was approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.

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“…For patients with advanced, incurable cancer, maximizing quality of life (QOL) is often an important goal of their overall care. Despite decades of advances, treatment with PN remains an involved, multistep process in order to safely administer PN to patients in the hospital or home [23,24]. In the home setting in particular, the patient and/or caregiver(s) needs to be trained to carry out all steps in HPN process for selfadministration as well as choose a dedicated clean area in the home for setup and disconnect, storage of PN, and organization of the multitude of supplies [23].…”

Section: Quality Of Life On Parenteral Nutrition In Cancer Patientsmentioning

confidence: 99%

The Role of Parenteral Nutrition for Incurable Cancer: Bridging Expectations and Reality

et al. 2021

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Purpose of ReviewIn this review, we examine the role for parenteral nutrition (PN) for nutritional support of patients with advanced, incurable cancer with an emphasis on bridging the divide between expectations and reality.Recent Findings As the rates of cancer have continued to rise worldwide, the utility of PN has continued to be studied. Due to multiple reasons, high-quality research studies have been scarce, and much of the data is based on observational studies. The recent trend appears to support the use of PN in carefully selected patients. Importantly, the effect on quality of life also should be considered when deciding to initiate PN. Summary PN can be a supportive lifeline for patients with advanced, incurable cancer. The medical team should consider each patient individually to decide if PN should be offered. It is of paramount important for the medical team to engage in shared decision-making with the patient and caregiver(s) to ensure that PN is aligned with their goals and wishes.

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Navigating the Challenges of Home Parenteral Nutrition

Cited by 6 publications

References 23 publications

Monitoring Response to Home Parenteral Nutrition in Adult Cancer Patients

Monitoring Response to Home Parenteral Nutrition in Adult Cancer Patients

Safe care transitions for patients receiving parenteral nutrition

The Role of Parenteral Nutrition for Incurable Cancer: Bridging Expectations and Reality

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