Name of the Procedure:

Parenteral Nutrition Solution: Carbohydrates (Dextrose) Greater Than 50% (500 ml = 1 Unit) - Home Mix
Common name: Home Parenteral Nutrition (HPN)
Technical/Medical term: Hypertonic Dextrose Infusion

Summary

This procedure involves the intravenous administration of a high concentration of carbohydrate solution, specifically dextrose greater than 50%. It is mixed and delivered to patients at home through a parenteral nutrition setup to provide essential energy and nutrients.

Purpose

This procedure is designed to provide nutritional support to patients who are unable to obtain adequate nutrition through oral or enteral routes. It helps maintain energy levels, promotes overall health, and prevents malnutrition.

Indications

• Severe gastrointestinal disorders
• Short bowel syndrome
• Chronic bowel obstruction
• Severe Crohn's disease
• Malabsorption syndromes
• Patients recovering from major surgery who cannot eat or digest food properly

Preparation

• Consultation with a healthcare provider to evaluate nutritional needs
• Blood tests and imaging studies to assess nutritional status and organ function
• Placement of a central venous catheter if not already in place
• Instruction on catheter care and aseptic techniques to prevent infection

Procedure Description

1. Prescription: A healthcare provider prescribes the specific formulation and volume of the dextrose solution.
2. Mixture Preparation: The solution is mixed according to the prescription, often prepared by specialized pharmacies.
3. Setup:
   • Patients or caregivers are trained to set up the infusion pump and IV line using aseptic techniques to prevent infection.
   • The dextrose solution is connected to the central venous catheter.
4. Infusion: The pump administers the solution over a specified period, typically several hours each day or overnight.
5. Monitoring: Regular monitoring of blood glucose levels, electrolyte balance, and signs of infection.

Duration

The infusion usually takes several hours (often 8-12 hours), depending on the individual’s nutritional needs and physician recommendations.

Setting

The procedure is performed at the patient's home under the supervision of trained healthcare providers or caregivers.

Personnel

• Dietitian/Nutritionist
• Home Health Nurse
• Pharmacist (for mixing the solution)
• Physician (for overall management and prescription)

Risks and Complications

• Common Risks:
  • Infection at the catheter site
  • Hyperglycemia
  • Electrolyte imbalances
• Rare Risks:
  • Central line-associated bloodstream infection (CLABSI)
  • Thrombosis
  • Liver dysfunction

Benefits

• Improved nutritional status and energy levels
• Prevention of weight loss and malnutrition
• Enhanced recovery and quality of life

Recovery

• Continuous monitoring of nutritional and metabolic parameters
• Regular follow-up appointments with healthcare providers
• Adherence to catheter care and infection prevention protocols

Alternatives

• Oral or enteral nutrition (e.g., tube feeding), if feasible
• Dietary modifications and supplementation
• Enteral nutrition may be less invasive but can be inadequate for some conditions.

Patient Experience

During the procedure, patients might experience:

• Minimal discomfort during catheter insertion
• The inconvenience of being connected to an infusion pump for several hours
• Potential need for blood glucose monitoring Post-procedure, patients often report fatigue relief and improved well-being. Pain management includes proper catheter care and prompt management of any discomfort or infection.