Home parenteral nutrition programs

Quality of life in long-term total parenteral nutrition patients and their family caregivers

The purpose of this study was to identify individual and family variables associated with patient and caregiver quality of life. Perceived quality of life has been associated with improved outcomes and compliance. Methods included telephone interviews of 178 families, randomly selected from academic, hospital, and infusion agencies across the United States, with 116 follow-up questionnaires returned. Patients had varied bowel disorders requiring total parenteral nutrition for an average of 4.6 years. Patients were an average of 52.0 years old; caregivers averaged 52.5 years of age. Coded interview data indicated that caregivers assist patients daily (for a mean of 4.2 hours) and provide emotional support. Problems such as loss of friends, loss of employment, and depression were reported in two thirds of the families. Overall low quality of life was associated with length of time on total parenteral nutrition, fewer family coping skills, and inability to get along on income, whereas higher quality of life was associated with higher self-esteem and quality in the relationship. Preparing families for potential social problems or situations related to depression while also enhancing financial assistance, self-esteem, quality in the relationship, and coping skills may increase both patient and caregiver quality of life.

An investigation into information provided for patients on home parenteral nutrition

A group of 34 patients who received home parenteral nutrition (HPN) were assessed by questionnaire to determine their knowledge of basic nutritional concepts, parenteral nutrition and the procedures used to monitor HPN. The results indicated that the HPN patients had an adequate knowledge of basic nutritional concepts and that this knowledge was not significantly different from that of 76 randomly selected control subjects. However, the HPN patients had significantly less understanding of parenteral nutrition and the procedures used to monitor HPN. Based on information obtained, a booklet was written to explain HPN to the same group of patients. Eighty-eight per cent of patients found the booklet either interesting or very interesting and 91% of patients reported that the booklet was read by other family members as well as themselves. Patients who had been on HPN for short periods of time learnt more from the booklet than other patients. Many patients would have appreciated more information about HPN when they first began treatment.

Total parenteral nutrition and tube feeding for elderly patients: findings of an OTA study

A 1987 report by the US Office of Technology Assessment (OTA), Life-Sustaining Technologies and the Elderly discusses current utilization of tube feeding and total parenteral nutrition (TPN) for elderly people and the related issues of patient access to treatment, decision making practices, and quality of care. Factors that limit access for some elderly patients include negative attitudes of some health professionals about whether elderly people can benefit from tube feeding and TPN, lack of adequate nutritional standards for the elderly and lack of staff in some treatment settings who are trained and have enough time to assess nutritional status in elderly patients, and payment problems. Public controversy about life-sustaining technologies for elderly people now focuses on decisions about withholding or withdrawal of tube feeding, but debate about the legal and ethical issues involved in these decisions tends to obscure the relevant clinical considerations. Research issues and clinical practice concerns related to decision making and quality of care for elderly patients on tube feeding and TPN are discussed.

100 patient-years of ambulatory home total parenteral nutrition

More than 100 patient-years' experience has been acquired in the treatment of 133 patients with ambulatory home total parenteral nutrition (TPN) between May 1974 and December 1983. Indications for chronic or permanent home TPN include short bowel syndrome, malabsorption, scleroderma, and vasoactive intestinal polypeptide syndrome. Indications for acute or temporary home TPN include Crohn's disease, malignancies, gastrointestinal fistulas, ulcerative colitis, anorexia nervosa, and numerous other disorders. Eighty-two patients in the acute group were treated primarily with percutaneously placed standard subclavian catheters and 51 patients in the chronic group have been treated thus far with implanted silicone rubber, Dacron-cuffed catheters for a cumulative total of 38,939 patient days. Of the 125 implanted catheters, 115 were placed in the superior vena cava and ten in the inferior vena cava for an average duration of 250 catheter-days, the longest single catheter remaining in situ for more than 8 1/2 years. Catheter-related sepsis occurred 33 times with the implanted catheters, or once every 2.6 catheter-years. One hundred and fourteen temporary catheters were placed percutaneously in the superior vena cava via a subclavian vein for an average duration of 68 days, the longest single catheter remaining in situ for 213 days. Catheter-related sepsis occurred seven times, equivalent to one episode per 3 catheter-years. Total catheter-related complications were quite infrequent and were directly related to duration of catheterization. They included venous thrombosis (12), clotted catheter (11), catheter failure or rupture (8), catheter compression (5) and inadvertent catheter removal (4). Twenty-six catheters were repaired or spliced in situ when the external segment was accidentally damaged or deteriorated secondary to long-term material fatigue. One remarkable patient has been maintained exclusively by TPN originally as an inpatient and subsequently as an outpatient for the entire 13 years of his life.

Behavioral management concepts with application for home parenteral nutrition patients

The concept of symptom-avoidance behavior is discussed, with particular reference to home intravenous hyperalimentation (HIVH) patients. Symptom-avoidance behavior is explained as a combination of a health behavior model and an expectancy motivational theory leading to a basic outcome, which is satisfactorily avoiding the onset of symptoms. A systematic behavioral assessment method is presented, based on anecdotal cases; it is experimental in nature and can serve as a guide for practitioners who wish to initiate HIVH.