Name of the Procedure:

Home Infusion Therapy, Total Parenteral Nutrition (TPN); One Liter Per Day. Commonly referred to as Home TPN or Home Intravenous Nutrition.

Summary

Home infusion therapy for Total Parenteral Nutrition (TPN) involves administering nutritional support directly into the bloodstream through a catheter, providing all necessary nutrients for individuals who cannot consume or absorb food through their digestive tract. This procedure includes administrative services, professional pharmacy services, care coordination, and necessary supplies and equipment.

Purpose

Home TPN is primarily used for patients with severe digestive tract disorders that prevent adequate nutrient absorption. The main goals are to ensure patients receive essential nutrients, maintain energy and strength, and improve overall health and quality of life.

Indications

• Severe Crohn's disease or ulcerative colitis
• Short bowel syndrome
• Chronic intestinal pseudo-obstruction
• Severe pancreatitis
• Radiation enteritis
• Congenital gastrointestinal anomalies
• Unable to meet nutritional needs through oral or enteral feeding

Preparation

• Initial evaluation by a healthcare provider
• Placement of a central venous catheter by a trained professional
• Instruction on catheter care, infusion pump operation, and recognizing complications
• Possible blood tests to determine nutritional needs and monitor liver and kidney functions

Procedure Description

1. Assessment and Setup:
   • Patient's medical history is reviewed.
   • Central venous catheter (if not already in place) is inserted surgically.
2. Nutritional Formula Preparation:
   • Standard TPN formula, including lipids and specialty amino acids, is prepared by a pharmacist.
3. Infusion Process:
   • TPN solution is infused through the central venous catheter using an infusion pump.
   • Typically administered overnight or as per patient convenience to ensure stability and minimize lifestyle disruption.
4. Monitoring:
   • Regular blood tests to monitor nutrient levels and organ function.
   • Ongoing assessment by healthcare providers.

Tools and Equipment:

• Central venous catheter
• Infusion pump
• TPN solution
• Supplies for catheter care

Anesthesia or Sedation:

• Local anesthesia for catheter placement if required.

Duration

The infusion usually takes 12-24 hours daily, depending on the patient’s needs and tolerance.

Setting

Performed at the patient's home, but the initial setup may occur in a hospital or outpatient clinic.

Personnel

• Pharmacists
• Home infusion nurses
• Healthcare providers specializing in nutrition
• Care coordinators

Risks and Complications

• Infection at catheter site
• Blood clots
• Liver dysfunction
• Metabolic bone disease
• Electrolyte imbalances
• Glucose abnormalities

Benefits

• Maintenance of nutritional status when oral or enteral feeding is not possible
• Improved energy and overall health
• Enhanced quality of life with the convenience of home-based care

Recovery

• Continuous, long-term management with regular monitoring
• Home TPN typically requires lifestyle adjustments but allows patients to live relatively normal lives.
• Regular follow-up appointments with healthcare providers

Alternatives

• Enteral feeding (tube feeding) if partial digestion is possible
• Oral nutritional supplements if digestive function allows
• Surgical correction of underlying gastrointestinal conditions, if feasible

Pros and Cons of Alternatives:

• Enteral feeding is less invasive but not always suitable.
• Oral supplements are easier but insufficient in severe cases.
• Surgery can be curative but also carries risks and may not be viable.

Patient Experience

• Initial discomfort during catheter placement
• Feeling of confinement due to infusion schedule
• Potential for minor pain or irritation at the catheter site
• Routine check-ups and support from healthcare providers and home care teams to manage any discomfort or complications