Name of the Procedure:

• Common name: Parenteral Nutrition Supply Kit (Premix)
• Technical/Medical term: HCPCS Code B4220

Summary

Parenteral nutrition is a method of delivering nutrients directly into the bloodstream for patients who cannot consume or absorb food orally. This supply kit contains all the necessary components for administering premixed nutritional solutions intravenously, typically on a daily basis.

Purpose

Parenteral nutrition is used to address severe gastrointestinal malfunctions or during recovery from surgeries that impair normal digestion. It ensures that the patient receives essential nutrients, vitamins, and minerals needed to maintain health and support recovery.

Indications

• Severe gastrointestinal disorders (e.g., Crohn's disease, short bowel syndrome)
• Post-surgical recovery impairing oral or enteral feeding
• Severe malnutrition or inability to absorb nutrients
• Inborn errors of metabolism

Preparation

• Patients may need blood tests to check for electrolyte imbalances and nutritional deficiencies.
• Adjustments in current medication may be required.
• The insertion of a central venous catheter by a healthcare professional will be necessary if not already in place.

Procedure Description

1. Assemble the parenteral nutrition supply kit including the premix solution, IV tubing, and infusion pump.
2. Ensure that the central venous catheter is clean and properly positioned.
3. Attach the IV tubing to the premix solution bag.
4. Prime the IV line to eliminate any air bubbles.
5. Connect the IV tubing to the patient’s central venous catheter.
6. Use an infusion pump to regulate the flow rate of the nutritional solution.
7. Monitor patient vitals and infusion site during administration.

The required tools include sterile premix nutrition bags, IV tubing, infusion pump, and central venous catheter.

Duration

The administration of parenteral nutrition typically takes between 12 to 24 hours per day, depending on the patient’s specific nutritional needs.

Setting

This procedure can be performed in various settings including hospitals, outpatient clinics, and within the patient’s home under professional supervision.

Personnel

• Registered Nurse (RN)
• Dietitian
• Physician or Specialist (e.g., Gastroenterologist)
• Pharmacist for preparation of the premix

Risks and Complications

• Infection at the catheter site
• Blood clots
• Metabolic imbalances
• Liver dysfunction
• Allergic reactions to components of the premix solution

Benefits

• Provides essential nutrients when oral or enteral feeding is not possible
• Supports patient recovery and overall health
• Can be administered at home, improving patient comfort and convenience

Recovery

• Continuous monitoring for signs of infection or complications.
• Regular blood tests to monitor nutritional status and adjust the mixture as needed.
• Patients may have restrictions on oral food intake.
• Scheduled follow-up appointments with healthcare providers for ongoing assessment.

Alternatives

• Enteral nutrition (tube feeding)
• Oral nutritional supplements if partial oral intake is possible
• Dietary modifications for those who can tolerate some foods

Patient Experience

Patients may feel limited freedom due to the need for continuous infusion and maintenance of the catheter. Pain management for catheter insertion site and ensuring the patient's comfort during long infusions are critical. Regular consultations with dietitians and healthcare teams help manage any discomfort and ensure the nutritional regimen is effective.