Name of the Procedure:

Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem (S9343).

Common name(s): Home Enteral Nutrition Therapy Technical/Medical terms: Enteral nutrition via bolus, Home enteral nutrition support (HENS), Home tube feeding

Summary

Home enteral nutrition therapy is a method of delivering nutrition directly into a patient's stomach or intestines through a feeding tube, performed at home. This comprehensive service includes administrative support, pharmacy services, coordination of care, and necessary supplies and equipment, excluding enteral formula and nursing visits, which are billed separately. It's primarily for individuals who cannot consume food orally but need adequate nutrition for their health and well-being.

Purpose

This procedure is designed for patients who cannot eat by mouth due to various medical conditions but still require sufficient nutrition to maintain their health. The goal is to ensure the patient receives the necessary nutrients to support their bodily functions, improve their quality of life, and prevent complications related to malnutrition.

Indications

• Severe swallowing disorders (e.g., dysphagia)
• Chronic gastrointestinal conditions (e.g., Crohn’s disease, ulcerative colitis)
• Neurological conditions affecting swallowing (e.g., stroke, ALS, Parkinson’s disease)
• Recovery from surgeries involving the digestive system
• Severe malnutrition or failure to thrive

Patient criteria include:

• Inability to consume adequate nutrition orally
• Functional gastrointestinal tract
• Stable medical condition suitable for home care

Preparation

• Patients might need to undergo an initial nutritional assessment by a dietitian.
• Instructions on managing the feeding tube should be provided, including how to keep it clean and functioning.
• Patients or caregivers should be educated on signs of complications and how to address them.
• No specific fasting or medication adjustments typically required.

Procedure Description

1. Assessment: Initial patient assessment by healthcare professionals, including dietitians and nurses.
2. Equipment Setup: Delivery and setup of the enteral feeding equipment and supplies at the patient's home.
3. Education: Training patient or caregiver on how to administer the enteral feedings, manage the feeding tube, and troubleshoot common issues.
4. Feeding Process: Administering the enteral nutrition via bolus method—feeding in small, regular intervals rather than continuous feeding. Typically involves a syringe or feeding pump.
5. Coordination and Support: Ongoing support and coordination from healthcare professionals, including dietitians, pharmacists, and nurses.

Duration

The feeding process can take about 20-30 minutes per session. The overall service is ongoing, tailored to each patient’s needs and condition.

Setting

This procedure is performed in the patient's home.

Personnel

• Registered Dietitians
• Nurses or Home Health Aides
• Pharmacists
• Care Coordinators

Risks and Complications

Common risks:

• Tube dislodgment or blockage
• Gastrointestinal discomfort or bloating
• Infection at the tube insertion site

Rare risks:

• Aspiration pneumonia (if feeding enters lungs)
• Severe allergic reactions to equipment or feed

Benefits

• Provides essential nutrition tailored to the patient's needs
• Allows patients to remain at home rather than in a hospital setting
• Improves overall health and quality of life by preventing malnutrition and related complications

Benefits can be realized soon after the patient starts receiving adequate nutrition.

Recovery

• Patients should follow the prescribed feeding schedule and care instructions.
• Regular follow-up appointments to monitor the patient's nutritional status and tube function.
• Recovery and adjustment period may vary; some may experience immediate improvement, while others might need time to adapt.

Alternatives

• Intravenous (IV) nutrition (Parenteral Nutrition)
• Trying different techniques to enable oral feeding if possible

Pros and cons of alternatives:

• IV Nutrition: Effective but requires venous access and has higher infection risks.
• Oral Feeding: More natural but might not be sufficient for all patients.

Patient Experience

Patients might experience some initial discomfort or anxiety about managing the feeding tube. Pain is usually minimal and manageable with appropriate care. Comfort measures include proper education and support from healthcare professionals to ensure smooth adjustment to this home-based therapy.