Name of the Procedure:

Parenteral Nutrition Solution: Carbohydrates (Dextrose), 50% or Less (500 ml = 1 Unit) - Home Mix (HCPCS Code B4164)

Summary

Parenteral nutrition solutions provide essential nutrients directly into the bloodstream via intravenous (IV) administration. This specific solution, which contains carbohydrates in the form of dextrose at a concentration of 50% or less, is designed for home mixing and use.

Purpose

Parenteral nutrition solutions are used to provide necessary calories and nutrients to individuals who cannot obtain adequate nutrition through oral or enteral (tube feeding) routes. The primary goal is to prevent malnutrition and maintain metabolic stability in patients with compromised digestive systems.

Indications

• Severe malnutrition
• Gastrointestinal disorders that prevent adequate food intake or absorption (e.g., Crohn's disease, bowel obstruction)
• Postoperative patients who cannot eat by mouth for extended periods
• Cancer patients undergoing intensive treatment affecting appetite and nutrient absorption

Preparation

• No specific fasting or dietary restrictions are required before starting parenteral nutrition.
• Blood tests may be conducted to assess baseline nutrient levels and kidney/liver function.
• The vascular access device (e.g., central venous catheter) must be properly placed and secured.

Procedure Description

1. A sterile solution containing dextrose is prepared under aseptic conditions.
2. An infusion pump is used to regulate the flow and dosage of the solution.
3. The solution is administered through a central venous catheter.
4. Continuous monitoring of the IV site and patient’s response is required.
5. Regular blood tests are conducted to monitor electrolytes, blood sugar, and overall metabolic status.

Duration

The duration varies depending on the patient's needs. It can range from several hours daily to 24-hour continuous infusion.

Setting

This procedure is typically performed at home using a home infusion setup coordinated by a healthcare provider.

Personnel

• Home infusion nurse
• Registered dietitian
• Primary care physician or specialist
• Possibly a pharmacist for solution preparation and management

Risks and Complications

• Infection at the catheter site
• Metabolic complications (e.g., hyperglycemia, electrolyte imbalances)
• Thrombosis or blood clots at the catheter site
• Liver dysfunction with long-term use

Benefits

• Provides essential nutrition for patients unable to eat or absorb nutrients
• Maintains metabolic stability and prevents malnutrition
• Can be administered at home, improving patient comfort and convenience

Recovery

• Post-procedure care includes regular monitoring of the infusion site and patient’s metabolic status.
• Patients may need follow-up appointments and regular blood tests.
• Full recovery from the underlying condition may vary and depends on individual circumstances.

Alternatives

• Enteral nutrition (tube feeding)
• Oral nutritional supplements and dietary modifications
• Depending on the condition, treatment specific to the gastrointestinal disorder

Patient Experience

• Patients may feel discomfort at the catheter site initially.
• Most individuals adjust to home infusion therapy and can manage it with minimal discomfort.
• Pain management strategies are available for any catheter site discomfort.
• Patients often feel better as their nutritional status improves.