Parenteral Nutrition in the Home and Alternate Sites Maintaining a checklist of all procedures essential to the patient and
caregiver will ensure that all areas are covered. Initial demonstration of each procedure should be done by the trainer, with a return demonstra- tion by the patient or caregiver to ensure proper technique. The check- list used during training in the hospital should then be transferred to the home care provider, who will continue the training process in the patient’s home. Figure 6.1 on page 100 provides an example of a check- list.27
Patients discharging to alternate sites may not need to be educated
on catheter care and infusion pump procedures, but they should receive education regarding therapy-related complications so that they can notify facility staff if they arise.
Self-Monitoring
Training patients in self-monitoring techniques to avoid complications of therapy is paramount to the safe infusion of PN in the home. All patients, whether at home or an alternate site, should be aware of the signs and symptoms of abnormal conditions, including those associated with fluid balance (eg, dehydration or overhydration), metabolic abnormali- ties (eg, hypoglycemia and hyperglycemia), and catheter-related com- plications. Patients receiving PN at home need to monitor themselves daily by recording their weight, temperature, intake, output, and blood glucose. Figure 6.2 on page 102 provides an example of a self-monitor- ing record.7,11,26-28
involved in monitoring intake and outputs but should still participate in this portion of their care.
Hydration
Dehydration is caused by inadequate fluid intake or excess loss of body fluids. Many patients cannot take oral fluids to maintain hydration and must receive their total daily fluid requirements from the PN. Various conditions can lead to dehydration, such as increased GI losses, fever, or diuretic use. Some home nutrition support providers will supply their patients with extra IV fluids to be kept on hand to treat the early signs of dehydration at home. These extra IV fluids can also be used to prevent dehydration in situations when a PN delivery cannot be made, such as a weather emergency. Excess provision of PN or IV fluids can lead to over- hydration. Patients should be aware of the signs and symptoms of dehy- dration and overhydration, and they should contact the home nutrition support provider when an imbalance occurs so that appropriate adjust- ments can be made to the PN formula (refer to Box 6.7 on page 101).23,29
99
Patients at alternate sites will have facility clinicians
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