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Transitioning the Nutritional Support Patient to Homecare
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Within a year of Dudrick’s invention of PN in 1968, a 36-year-old woman with extensive intraperitoneal metastatic ovarian carcinoma became the first patient to be treated with intravenous nutrition at home (Jeejeebhoy et al. 1976). In the decade that followed, physicians in the US, Canada and France showed that home parenteral nutrition was feasible and should be considered for patients who were entirely dependent on PN. It became apparent that patients receiving HPN were not only surviving but thriving on the therapy (Hurt and Steiger 2018).
Meeting personal needs: hydration and nutrition
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Enteral feeding may be used to supplement or completely replace oral intake. It can be administered by bolus, intermittently or continuously. Enteral feeding might be done to maintain adequate nutrition for a person with severe neurological impairment as a result of cerebral palsy or stroke where swallowing is extremely difficult or hazardous, or for people whose nutritional needs exceed their oral intake, owing to a health problem. All enteral feeding methods have benefits and hazards associated with them. These are discussed later in this section. It is therefore imperative that this procedure is done under the supervision of a qualified practitioner. Medicines may be prescribed via the enteral tube route, and this procedure is also included in this section. In some circumstances, the enteral route cannot be used, and this section also identifies the role of parenteral nutrition and intravenous fluid administration. The use of enteral feeding has gained popularity over recent years, and many people now receive home parenteral and enteral nutrition. Wanten (2011) explains how home parenteral nutrition is the treatment of choice for people with long-term intestinal failure. NICE (2020) provides detailed, evidence-based guidelines relating to enteral and parenteral feeding; these are recommended further reading.
Home Parenteral Nutrition*
Published in Fima Lifshitz, Childhood Nutrition, 2020
Adib A. Moukarzel, Marvin E. Ament
Home parenteral nutrition (HPN) is the provision of parenteral nutrition (PN) in infants, children, and adults in a non-hospital setting. The goal of HPN is to achieve positive nitrogen balance, weight gain, and to improve clinical outcome in patients who do not have adequate gastrointestinal tract function. HPN has saved the lives of many patients who previously might have died with catastrophic gastrointestinal conditions. Since its inception almost 25 years ago, the use of HPN has increased tremendously, and it has become accepted as a useful supportive and therapeutic technique for a variety of gastrointestinal diseases and conditions. In the United States, it is estimated that there are over 19,000 patients on home parenteral nutrition. We have treated more than 1000 patients for 18 years with HPN for over 100,000 days of therapy. The mean patient days on HPN has been nearly 1000 days, and the longest period for any single patient has been well over 16 years. Half of the patients we are currently following have received parenteral support at home for 8 or more years. Many of our patients are infants and children.
The safety of available treatment options for short bowel syndrome and unmet needs
Published in Expert Opinion on Drug Safety, 2021
Loris Pironi, Emanuel Raschi, Anna Simona Sasdelli
IVS is the primary and life-saving nutritional therapy of chronic IF [5]. It is provided at the patient’s home through home parenteral nutrition (HPN) programs in the subsequent phases [7]. SBS-IF is burdened by the risk of severe PN/IF-related complications, such as central venous access device (CVAD)-related sepsis and deep vein thrombosis, intestinal failure associated liver disease (IFALD), and by impaired quality of life (QoL) [8]. In adults, the SBS-IF patient 5-year survival rate on HPN is around 70%, with around 11–14% of deaths due to PN/IF-related complications [9]. The autologous gastrointestinal reconstructive surgery procedures for SBS are categorized as restoration of intestinal continuity in case of unused intestinal segments, reversed intestinal segments (adult patients), tapering enteroplasty or plication, and lengthening procedures (mostly in pediatric patients) [10]. Intestinal transplantation (ITx) is the curative option for chronic irreversible IF [11]. Successful ITx can determine an improvement of QoL [12]. ITx is recommended as life-saving treatment for all the patients at risk of death because PN/IF complications. Patient’s referral to ITx for improving QoL requires a careful case-by-case decision [13].
Home Parenteral Nutrition in Patients with Advanced Cancer: A Systematic Review and Meta-Analysis
Published in Nutrition and Cancer, 2021
Francis J. O’Hanlon, Konstantinos C. Fragkos, Lucia Fini, Pinal S. Patel, Shameer J. Mehta, Farooq Rahman, Simona Di Caro
As treatments continue to evolve, patients are increasingly able to survive for longer with a cancer diagnosis. In turn, malnutrition impairs the body’s ability to withstand anticancer therapies such as chemo/radiotherapy or surgery (11). In the context of malignant intestinal failure (in patients with cancer), current guidelines recommend that home parenteral nutrition (HPN) is indicated when expected survival is greater than 2–3 mo; parenteral nutrition (PN) is expected to stabilize or improve performance status and/or quality of life; with the provision that the patient desires it (10, 12, 13). Once a stable PN regimen has been started, a subset of patients may be able to continue receiving HPN. Although patients with cancer account for a significant and increasing proportion of patients receiving HPN within Europe (14, 15), the issue remains controversial and access to PN varies both nationally and internationally (16).
Performance Status, Prognostic Scoring, and Parenteral Nutrition Requirements Predict Survival in Patients with Advanced Cancer Receiving Home Parenteral Nutrition
Published in Nutrition and Cancer, 2018
Niamh Keane, Konstantinos C. Fragkos, Pinal S. Patel, Friderike Bertsch, Shameer J. Mehta, Simona Di Caro, Farooq Rahman
Artificial nutrition may be indicated in malnourished oncology patients who cannot autonomously meet their nutritional requirements (1). In the last decade, there has been an increased trend in referrals and this cohort currently represent the commonest indication for home parenteral nutrition (HPN) worldwide. Nevertheless, the use of long-term HPN in advanced/incurable (previously referred to as palliative) cancer patients remains controversial in the UK (1–6). Timely commencement of HPN is considered in advanced cancer patients with an acceptable quality of life who would die from malnutrition-related complications (and in some cases starvation) before tumor progression (3,5,7). Cachexia is prevalent in more than 50% of patients with advanced cancer and can lead to death in more than 10% of subjects (8–10).