The Role of a Nutrition Support Team in the Management of Intestinal Failure Patients

Abstract

Parenteral nutrition (PN) is a complex and specialized form of nutrition support that has revolutionized the care for both pediatric and adult patients with acute and chronic intestinal failure (IF). This has led to the development of multidisciplinary teams focused on the management of patients receiving PN: nutrition support teams (NSTs). In this review we aim to discuss the historical aspects of IF management and NST development, and the practice, composition, and effectiveness of multidisciplinary care by NSTs in patients with IF. We also discuss the experience of two IF centers as an example of contemporary NSTs at work. An NST usually consists of at least a physician, nurse, dietitian, and pharmacist. Multidisciplinary care by an NST leads to fewer complications including infection and electrolyte disturbances, and better survival for patients receiving short- and long-term PN. Furthermore, it leads to a decrease in inappropriate prescriptions of short-term PN leading to significant cost reduction. Complex care for patients receiving PN necessitates close collaboration between team members and NSTs from other centers to optimize safety and effectiveness of PN use.

Continuous feeding via gastrostomy in short bowel syndrome

“…The important factor in weaning off PN is the residual bowel length, gestational age, presence of an ileal segment and/or ileocecal valve, and colon length. Mortality in SBS has decreased from 30% to 10% over 5 years, which probably reflects the impact of multidisciplinary intestinal rehabilitation programs on patient outcomes 3,4 . Joly et al .…”

“…Mortality in SBS has decreased from 30% to 10% over 5 years, which probably reflects the impact of multidisciplinary intestinal rehabilitation programs on patient outcomes. 3,4 Joly et al indicated that continuous tube feeding could improve intestinal absorption and adaptation in SBS. 5 Despite an extremely short bowel, with only 27 cm remaining of the small intestine, this patient with continuous feeding via gastrostomy tube was able to wean from PN within 9 months after birth and is developing well.…”

Nutrition Management of the High‐Output Fistulae

“…A few key components in monitoring the home PN patient include laboratory results, blood glucose readings or urine glucose testing, intake and output records, assessment of weight changes, and preservation of bone and liver health. 74 Focusing on only laboratory results, for example, does not portray a complete clinical picture of the patient's needs and how to best provide care. Many of these items can be addressed remotely but should never fully take the place of an outpatient's in-person visit.…”

“…For patients who have high‐output ECFs and require PN support therapy after discharge, follow‐up from a multidisciplinary home nutrition support team is essential 74 . Some advantages include fewer electrolyte abnormalities and central line–associated bloodstream infections as well as a decrease in mortality 74 .…”

“…For patients who have high‐output ECFs and require PN support therapy after discharge, follow‐up from a multidisciplinary home nutrition support team is essential 74 . Some advantages include fewer electrolyte abnormalities and central line–associated bloodstream infections as well as a decrease in mortality 74 . Vital members of the home nutrition support team include a referring physician, nutrition support practitioners, such as registered dietitians, home care agencies, and pharmacies 75 .…”