WHAT PS DOES
Long-term parenteral support (PS) is used for the treatment of people who are unable to absorb enough nutrients and fluids from food to support health.1–4
PS provides nutrients and fluids by vein into the bloodstream, bypassing the normal process of food absorption and digestion that normally occurs in the gastrointestinal tract.1–4
This provides all the necessary nutrients and fluids that would normally be obtained by eating and drinking.4
- Jeppesen PB. JPEN J Parenter Enteral Nutr. 2014;38(1 Suppl):8S–13S.
- O'Keefe SJ, et al. Clin Gastroenterol Hepatol. 2006;4(1):6–10.
- Buchman AL, et al. Gastroenterology. 2003;124(4):1111–1134.
- Staun et al. Clin Nutr. 2009;28:467–479.
FORMULATION OF PARENTERAL SUPPORT
HOME PARENTERAL NUTRITION
Home parenteral nutrition (HPN) refers to the administration of PS at home and is available in some countries.
Home treatment is the preferred option for people with short bowl syndrome with intestinal failure (SBS-IF) requiring long-term PS because it offers more freedom and provides the opportunity for you to self-manage your own condition.
REQUIREMENTS FOR HPN
If you want to be treated by HPN, you will need to show willingness and ability to self-manage your condition at home. To be discharged from the hospital and be allowed to manage HPN, you and/or your carers should meet the requirements below:1
- Be physically and emotionally capable of carrying out the HPN therapy
- Understand the importance of hygiene when conducting HPN
- Demonstrate the ability to administer HPN safely and effectively
- Identify and respond to specific problems and symptoms that could develop with the use of HPN
- Be independent or have adequate care and support
- Have a home environment with a clean space to prepare and conduct HPN
- Have access to a refrigerator to store the HPN solution, if needed
- Have a working telephone and contact details of the nursing team, emergency services and the HPN delivery team
- Pironi L, et al. Clin Nutr. 2016;35(2):247–307.
HOW HPN IS CARRIED OUT
HPN is administered through a needle that is placed into a large vein known as a central venous catheter.1,2
HPN normally lasts 10–12 hours a day, and is needed for 5–7 sessions each week.1,2 Most people administer their parenteral nutrition infusion overnight on a pump so they can be free from treatment during the day.3
However, because HPN can cause the need to urinate during the night, it may interfere with and reduce sleep quality.1 As a result, some people prefer having HPN during the day.
To minimise the risk of infection, HPN must be administered in a clean environment and the catheter should remain in the same position. External tubing should be changed regularly, with dressings being kept sterile and replaced as advised by your doctor or nurse.2,3
The nutrient and fluid solution that is pumped should be stored in a fridge, but the adequate dose should be taken out 4–6 hours before administration to allow enough time to reach room temperature.2
Do not self-administer HPN unless trained by your doctor or nurse.
Consult your doctor or nurse for more information.
- Staun M, et al. Clinical Nutrition 28 (2009) 467–479.
- Healthline. Parenteral Nutrition. Accessed from: https://www.healthline.com/health/parenteral-nutrition. Date accessed April 2020.
- Home parenteral nutrition (HPN) information for patients and carers. UHB NHS. Accessed from: https://www.uhb.nhs.uk/Downloads/pdf/PiHomeParenteralNutrition.pdf. Date accessed: April 2020.
While PS is a life-saving therapy for people with SBS-IF, its long-term use can lead to serious complications such as infections, sepsis, kidney failure and liver failure.1–3
Catheter-related infections are the most common complication associated with the use of PS, accounting for most hospitalisations of people with SBS-IF.1–3
Complications due to PS account for half of all hospitalisations for people with SBS-IF, with one study showing that within a 12-month period hospitalised patients spent on average 23 days in hospital.3
Ensure you follow the guidance provided by your healthcare professional to minimise the risk of infection while using HPN.
- Hofstetter S, et al. Curr Med Res Opin. 2013;29(5):495–504.
- Buchman AL. Dig Dis Sci. 2001;46(1):1–18.
- Van Gossum A, et al. Clin Nutr. 2001;20(3):205–10.
Date of preparation: April 2020 C-ANPROM/INT//7389