Parenteral Nutrition in the Home and Alternate Sites


would benefit from a referral to psychiatry for strategies to cope with the primary disease, any new diagnoses, or the PN therapy.6


The social


worker assesses safety of PN therapy in the home setting (eg, clean home environment, electricity, running water, telephone, and appropriate stor- age for supplies).7


Discharge planner facilitates discharge planning, including verifying insurance benefits for HPN, arranging home infusion pharmacies for supplies, and coordinating routine home care nursing visits for contin- ued HPN training and other therapies. The discharge planner facilitates transfer to an alternate site as needed. Acts as the liaison between the patient and all health care members involved in the patient’s discharge planning.8


Indications and Contraindications for Home Parenteral Nutrition


Appropriate patient selection for HPN is important to prevent compli- cations related to this complex therapy. The indicators for HPN are the same as those for hospitalized patients requiring PN. However, in patients receiving HPN, the failure of gastrointestinal (GI) function is expected to be long term and the acute care services of a hospital are no longer needed. Established indications for HPN are listed in Box 6.1.9


BOX 6.1 Indications for Home Parenteral Nutrition9


Dysmotility disorder Inflammatory bowel disease Intestinal and pancreatic fistula Intestinal ischemia Intestinal obstruction


Malabsorptive syndromes Pancreatitis Radiation enteritis


Short bowel syndrome with or without stoma


While most patients start PN during a hospital admission, initiation


of PN in the home has been found to be safe and potentially cost saving in certain situations.9-12


Conditions where home initiation of PN should


be avoided or used cautiously are presented in Box 6.2 on page 90.10-12 Box 6.3 on page 90 lists social issues that are potential contraindications to HPN.1,11


Patients with these issues require closer monitoring and fol- low-up if moved to HPN. 89


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