Home Parenteral Nutrition Procedure
Overview
Parenteral nutrition (PN) gives nutrients directly into the bloodstream when the digestive system cannot process food normally. This method delivers vital elements like carbohydrates, proteins, fats, vitamins, minerals, and electrolytes in liquid form through an intravenous (IV) line. PN can be used on its own or alongside enteral nutrition, which uses a tube to deliver nutrients to the stomach or intestine.
For those with long-term needs, patients can receive treatment at home, often called home parenteral nutrition (HPN). HPN helps people who cannot absorb or tolerate food taken by mouth. Some may require it for a short time, while others may use HPN for months or even for life.
Types of Parenteral Nutrition:
| Type | Description |
|---|---|
| Total Parenteral Nutrition (TPN) | Provides all daily nutritional needs by IV. |
| Home Parenteral Nutrition (HPN) | TPN is provided outside of the hospital, usually at home. |
Reasons for Using Parenteral Nutrition
Doctors use parenteral nutrition when the body cannot digest or absorb enough nutrients from regular food. This type of therapy often helps people with certain medical problems that affect the digestive system. Common reasons include:
| Condition | Reason for Parenteral Nutrition |
|---|---|
| Short bowel syndrome | Not enough intestine to absorb nutrients. |
| Crohn’s disease | Inflammation interferes with food absorption. |
| Cancer | Blockage or damage to the digestive tract. |
| Liver disease | Problems with how the bowel works. |
| Ischemic bowel disease | Poor blood flow damages bowel function. |
- Intestinal failure due to conditions like short bowel syndrome. Here, the intestine is too short to take in enough nutrients, either from birth or after surgery.
- Severe bowel disorders such as Crohn’s disease or ischemic bowel disease. Inflammation, blockages, or bad blood flow prevent proper digestion and absorption of food.
- Cancer of the digestive system. Tumors or treatment side effects may block or damage parts of the gut, so the body cannot get what it needs from eating.
- Liver disease and other problems that affect how the bowel works can also make this type of support necessary.
Possible Risks
Parenteral nutrition, which uses a central line, comes with several risks. Infections at the catheter site are common and require quick treatment. Blood clots may form in the veins where the central line is placed.
Other risks include fluid and mineral imbalances, as well as issues with blood sugar. Over time, patients may develop liver problems or have too much or too little of certain minerals like iron or zinc.
| Risk | Description |
|---|---|
| Catheter infection | Infection at the central line site. |
| Blood clots | Blockage in veins from central line. |
| Fluid/electrolyte issues | Imbalance of fluids and minerals. |
| Blood sugar problems | Trouble keeping blood sugar normal. |
| Liver changes | Liver disease linked to long-term use. |
| Trace element issues | Iron or zinc too high or low. |
What You Should Know About the Process
Getting Ready
Healthcare professionals, including doctors with nutrition expertise and pharmacists, choose the right type of catheter for the patient. Catheters may be partly outside the skin, such as a tunneled line, or completely under the skin, such as an implanted device.
Before starting, nurses and the care team make sure the patient and caregivers understand how to store and handle the nutrition solutions. Education includes instructions about the nutrients involved—proteins, fats, carbohydrates, vitamins, minerals, water, and electrolytes. Infusion pumps may also be discussed so the patient knows what to expect.
Putting the Catheter in Place
Medical staff perform the procedure in a hospital or medical setting. They usually give the patient medicine to help them relax or sleep. The team places the catheter into a large vein near the heart to allow quick delivery of the custom nutrition solution.
Pharmacists ensure the formulation is stable and safe for infusion. Nurses check the equipment and make sure all supplies are ready, such as the infusion pump and sterile dressings. This helps lower the risk of infection and keeps the process smooth.
What Happens Afterward
After inserting the catheter, the care team watches for any problems like redness or swelling. Blood tests help the doctor and nurse monitor how the patient’s body is using the nutrients. They also check the balance of fluid and electrolytes.
Regular visits with physicians help adjust the formula if needed. If the patient is able to eat more by mouth or through a feeding tube, doctors may slowly decrease the amount of parenteral nutrition, with plans to eventually stop it if possible.
Findings
Many people using home parenteral nutrition and their caregivers learn how to safely mix and use the nutrients. The nightly infusion schedule often allows for more flexibility during the day. Reports show that quality of life for those on parenteral nutrition is often close to people on dialysis.
Common Experiences
- Feeling tired or fatigued.
- Achieving a sense of independence during the day.
- Support from trained health professionals.
