CHAPTER 6 Routine Follow-Up Appointments


Monitoring for PN complications—whether metabolic, mechanical, or infectious—is important because therapy may need to be temporarily interrupted to resolve these issues (see Chapter 5 for more on compli- cations associated with PN). For patients at home, routine outpatient clinic follow-up is necessary to physically examine the patient, complete a nutrition focused physical examination, evaluate functional status, assess for nutrient deficiencies or excesses, inspect the CVAD, and eval- uate the patient’s psychosocial status.26,29


These appointments can be


in-person or virtual, but it is important to note that there are limitations to virtual visits (eg, limited physical examination, concerns for bad video or audio connection).26


evaluated routinely by the facility’s clinicians but may still require regu- lar follow-up visits with specialists, including nutrition support provid- ers. Box 6.11 provides an example of a clinic follow-up schedule.


BOX 6.11 Example of Routine Clinic Follow-Up Schedule Time frame


Evaluation


1 month after start of therapy


Complete nutrition focused physical examination. Inspect the vascular access device.


Assess tolerance to therapy, functional status, and any concerns the patient has with home parenteral nutrition therapy.


Assess quality of life (QOL).


3 months after start of therapy


Every 6 months to 1 year


Same as above. Reassess nutrition goals. Assess QOL.


Same as above.


Evaluate and address any long-term complications of therapy (eg, metabolic bone disease, or parenteral nutrition–associated liver disease).


Assess QOL. Patients at alternate sites will be monitored and


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