Home Parenteral Nutrition

-
Long-term home parenteral nutrition (HPN) is a life-saving therapy for patients with chronic intestinal failure (Fessler, 2011). The most common indications for parenteral nutrition (PN) in the home include “severe short bowel syndrome-insufficient enteral absorptive capacity; complete small bowel obstruction with failure of enteral tube feeding; malnutrition with malabsorption that has not improved with the use of medications or altered nutrient content of enteral formulas; malnutrition and motility disorder that has not improved with medications; high output enterocutaneous fistula with inability to enteral feed distal to it; inability to maintain nutrition/hydration due to high ostomy output that has improved with the use of medications” (Fessler, 2011; Nelson, 2007).

Interdisciplinary involvement by the health care team is important for effective patient care in the home and is an area of ASPEN focus. Collaboration among team members including physicians, nurses, dietitians, and pharmacists, are important to monitor and manage patients on HPN. Interdisciplinary collaboration in all aspects of care can potentially improve quality of patient care and outcomes (Fessler, 2011).

As the concept of HPN has grown, it has become apparent that there is a need for dietitians in the care of patients receiving parenteral support at home. For dietitians involved in home care, the issues to consider include:

  • Determination of medical necessity and financial coverage
  • Determination of goals of therapy
  • HPN monitoring
  • Electrolyte disturbances and hydration status
  • Appropriate diet advancement (when possible)
  • Signs of infection
  • Micronutrient status
  • Long-term PN complications
  • Liver and bone health
  • Quality of life and psychosocial issues

A summary statement for the above issues are discussed in the article.

References

Fessler, T. (2011). Optimizing care in home parenteral nutrition: the RD’s role. Today’s Dietitian, 13(7), 38.

 Nelson, M. (2007). Medicare reimbursement of home nutrition support. Today’s Dietitian, 9(1), 12-21. 

CP

Comments

Post a Comment

Popular posts from this blog

Do you struggle with pre and post exercise nutrition?

-
Image
What should i eat before and after a workout? First things first…carbohydrates, proteins and fats are important for the body before  and after exercise. Exercising muscle preferentially uses carbohydrates from stored glycogen, but fats are also an important fuel source for energy production during exercise. Fats and carbohydrates are the two major fuel sources during exercise. Fats must be translocated and broken down from their storage form before they are used. Typically there is enough carbohydrate stored as muscle glycogen for exercise but as muscle glycogen stores decline, the skeletal muscle will then use some amino acids (basic components of all protein). More specifically, the amino acid leucine is used for energy.              It is important to consume an adequate amount of carbohydrates exercise to delay fatigue and minimize gastrointestinal distress. It is also important to consume enough fluids to prev...
Read more

Child Malnutrition

-
New approach to childhood malnutrition may reduce relapses, deaths http://www.sciencedaily.com/releases/2015/02/150211124024.htm               Moderate acute malnutrition is experienced by 35 million children worldwide. A new study led by researchers from Washington University School of Medicine in St. Louis has suggested that feeding children until they have met target measures of arm circumference and weight may be more important than a set 12 week feeding time. However, researchers have found that the current targets, set by the World Health Organization (WHO) may not be sufficient and raising these targets slightly could significantly reduce the risk of relapse in malnourished children; a condition that has a 37% relapse rate. The study took place in rural Malawi and was comprised of 2,349 moderately malnourished children aged 6 months to 5 years old. Children were evaluated 12 months after treatment; 1,967 rec...
Read more

Harvest of the Month

-
Image
Harvest of the Month  August – Corn Good source of  fiber Carbohydrate source for energy Antioxidants Contains vitamins and minerals ½ cup or 1 ear = 80 calories   http://www.whfoods.com/genpage.php?tname=foodspice&dbid=90 September – Watermelon High in vitamin A and vitamin C Antioxidants and anti-inflammatory support 1 cup cubed = 46 calories http://www.whfoods.com/genpage.php?tname=foodspice&dbid=31 October – Apples High in fiber Vitamin C Abundant amount of antioxidants 1 medium = 95 calories  http://www.whfoods.com/genpage.php?tname=foodspice&dbid=15 November – Squash and Pumpkin High in vitamin A, vitamin C, vitamin K, vitamin B2, B3 & B6 Many minerals  High in fiber Multiple antioxidant properties  1 cup = 76 calories  http://www.whfoods.com/genpage.php?tname=foodspice&dbid=63 Decembe...
Read more