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Southern Alberta Home Nutrition Program

The Southern Alberta Home Parenteral and Enteral Nutrition Program

Parenteral Nutrition

Home Parenteral Nutrition Objectives:

  1. To enhance quality of life for individuals by enabling them to safely receive parenteral nutrition at home
  2. To maintain or improve nutritional status of individuals who would otherwise be required to stay in an acute care hospital
  3. To reduce hospitalizations
  4. To facilitate discharge from hospital to home

Home Parenteral Nutrition Admission Criteria:

  • Patients admitted to the program are incapable of meeting their nutritional requirements via the gastrointestinal tract
  • Anticipated duration of home parenteral nutrition is a minimum of one month
  • Patients/care-givers agree to participate and have access to appropriate care giver support if required
  • Patients are agreeable to consultation with psychosocial services for assessment if necessary
  • Patients/family/caregivers are willing to assume responsibility for and must exhibit ability to learn and carry out the parenteral nutrition procedures in a safe and independent manner
  • Patients/family/caregivers are free from complicating disorders that would jeopardize their safety while receiving parenteral nutrition at home
  • Patients/family/caregivers agree to devote adequate time to be educated in the principles and safe practices related to central venous catheter care and intravenous infusion
  • Patients/family/caregivers agree to follow up visits from a program nurse and/or home care nurse for the purpose of guidance and assessment of adherence to the principles and practices of safe parenteral nutrition therapy
  • Patients will have a primary care physician who assumes responsibility for medical follow-up
  • Patients will maintain contact with the Nutrition Support Clinic for regular monitoring of nutritional progress and venous access status while receiving home parenteral nutrition
  • Parenteral nutrition may not be indicated in palliative situations wherein benefits to the patient cannot be identified

Process:

Referrals must be made to the Southern Alberta Parenteral and Enteral Nutrition Program. Referrals will be reviewed by the Nutrition Support Team prior to acceptance to the program. The multidisciplinary nutrition support team assesses each situation together with the patient considering:

  • Program admission criteria
  • Medical status
  • Suitability of the home environment
  • Patient willingness
  • Learning ability of the patient/family/caregiver
  • Nutrient requirements
  • Short and long-term nutritional goals

Home Parenteral Nutrition Therapy Termination:

Parenteral Nutrition is discontinued when:

  • The patient’s nutrient requirements can be met via the gastrointestinal tract
  • The patient’s medical condition or complication status so indicates
  • The physician and/or patient judge that the patient no longer benefits from the therapy

Enteral Nutrition

Home Enteral Nutrition Objectives:

  1. To enhance quality of life for individuals by enabling them to safely receive enteral nutrition at home
  2. To maintain or improve nutritional status of individuals who would otherwise be required to stay in an acute care hospital
  3. To reduce hospitalizations
  4. To facilitate discharge from hospital to home

Home Enteral Nutrition Admission Criteria:

  • Patients are incapable of meeting their nutritional requirements orally
  • Anticipated minimum duration of home enteral nutrition is one month
  • All feeding provided by the program will be provided via a feeding tube
  • Patient/family are willing to participate and have access to appropriate care giver support if required
  • Patients are free from complicating disorders that would jeopardize their safety while tube feeding at home
  • Patients and/or caregivers consent to devote adequate time to be educated in the principles and safe practices related to tube feeding
  • Patients will have a primary care physician who assumes responsibility for medical follow-up
  • Patients will maintain contact with the Southern Alberta Nutrition Support Clinic for regular monitoring of nutrition progress and feeding access status while receiving home enteral nutrition.

Home Enteral Nutrition Process:

Referrals must be made to the Southern Alberta Parenteral and Enteral Nutrition Program. Referrals will be reviewed by the Nutrition Support Team prior to acceptance to the program. The multidisciplinary nutrition support team assesses each situation together with the patient considering:

  1. Admission criteria are met
  2. Feasibility for safe enteral nutrition therapy at home
  3. Appropriate nutrient intake based on individual requirements and nutritional goals

Nutrition Support Care Plan

Once it is decided that a patient is a candidate for home nutrition support, the specifics of care will be established through the nutrition care team which is multi-disciplinary involving a physician, registered dietitian, registered nurse and where appropriate a social worker. All these health experts are involved in providing care for patients who meet the criteria for home enteral or parenteral nutrition. The care plan includes the following:

  1. Define the individual’s nutritional goals
  2. Create a patient-specific nutrient prescription
  3. Select the appropriate route for providing nutrients
  4. Select the appropriate delivery device
  5. Establish a schedule for administration of enteral/parenteral therapy
  6. Provide teaching to the patient and family member where appropriate to infuse nutrients through the best route
  7. Determine a plan for safe storage and preparation of formulas, management of equipment and for site care
  8. Establish a plan for monitoring nutrition therapy.

Adequacy of the home environment:

  1. Clean place for preparation of parenteral nutrition
  2. Dependable refrigeration
  3. Appropriate storage space
  4. Adequate lighting and electricity
  5. Phone service and access to emergency medical services

Potential long-term complications of parenteral nutrition:

  1. Sepsis/Infection – Particularly of the central venous catheter. This can be life threatening and if suspected needs to be addressed by your physician or nutrition support team without delay
  2. Liver and Gallbladder Disease – There are many hepatobiliary complications that can arise form long term PN use. These include steatosis (fatty liver), cholestasis, and cholelithiasis (gallstones). Advanced liver disease is one of the main reasons that patients receiving long term PN may require assessment for liver and small bowel transplantation. Therefore, this can be life threatening. The nutrition support team may institute many measures to prevent against advanced liver disease from transpiring. These measures include optimization of the PN formula, change of lipid emulsion, and treatment with medications such as urso and antibiotics in addition to other modifications.
  3. Metabolic Bone Disease – Between 40-100% of patients on long term PN have decreased bone density or evidence of metabolic bone disease. This is due to multiple factors, including both PN itself and in combination with the underlying illness. If we suspect bone disease, we will refer you to an endocrinologist for further assessment and management.
  4. Electrolyte and fluid abnormalities – These are potentially problematic issues in all patients receiving home parenteral nutrition. Therefore, we request regular labwork monitoring to be performed at specific intervals. These intervals may change depending on your clinical picture. It is mandatory that compliance with this monitoring strategy is achieved.
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