Clinical Review

Managing adult patients who need home parenteral nutrition

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1447 (Published 18 March 2011) Cite this as: BMJ 2011;342:d1447
  1. Geert Wanten, gastroenterologist, head of nutrition support team1,
  2. Philip C Calder, professor of nutritional immunology2,
  3. Alastair Forbes, professor of gastroenterology and clinical nutrition3
  1. 1Department of Gastroenterology and Hepatology, Radboud University, Nijmegen Medical Centre, 6500 HB Nijmegen, Netherlands
  2. 2Institute of Human Nutrition, University of Southampton, Southampton, UK
  3. 3Department of Gastroenterology, University College London Hospitals, London, UK
  1. Correspondence to: G Wanten g.wanten{at}mdl.umcn.nl

Summary points

  • Home parenteral nutrition is the treatment of choice for patients with long term intestinal failure

  • It should be supervised by an experienced team that trains patients in best management

  • In some patients it is associated with substantial impairment in quality of life

  • Survival is mainly determined by the primary disease

  • The main problems stem from venous access related complications

  • Liver dysfunction and altered bone mineralisation are common adverse effects

  • New strategies to improve outcomes include use of intestinotrophic factors to promote intestinal adaptation and new lipid formulations to modulate immune function

Patients with intestinal failure—defined as failure to maintain protein-energy balance, fluid balance, electrolyte balance, or micronutrient balance when eating a normal diet as a result of surgery, bowel disease, or a congenital defect—require parenteral nutrition (see box 1 for full definition). Since its introduction in 1967, intravenous nutrition administered in the home has been the mainstay of treatment for patients with long term intestinal failure. Home parenteral nutrition is a clinically important way to supply certain patients with their long term nutritional requirements, but high rates of complications are a worry. Although patients’ survival largely depends on the underlying disease, adverse events related to venous access and metabolic disturbances associated with the delivery of parenteral nutrition may compromise quality of life. We provide an overview of the indications for and delivery of home parenteral nutrition and discuss advances that promise to limit complications and improve treatment outcomes. This review is based largely on recent guidelines and on observational evidence.

Sources and selection criteria

We searched PubMed for articles in English on home parenteral nutrition. We also consulted guidelines issued by the European Society for Clinical Nutrition and Metabolism (ESPEN) that are based on grade A (randomised controlled trials), grade B (non-randomised studies), and grade C (expert opinion) evidence.1

Box 1 Definition of intestinal failure and short bowel syndrome2

Intestinal failure is caused …

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