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Home Parenteral Nutrition in Gastrointestinal Cancer Patients Improves Quality of Life

Parenteral nutrition can be a life-saving treatment, providing nutrients necessary to obtain or maintain an adequate nutritional status when enteral nutrition is problematic.  TPN may be the only option available to meet nutritional demands when the gastrointestinal tract is compromised, either temporarily or permanently.

There are several diagnoses or conditions that can cause alteration in absorption of nutrients by the GI tract to the extent that adequate nutrition is unattainable by the oral or enteral route. Since it is always better to provide nutrition via the GI tract whenever possible, TPN should be utilized as the sole source of nutrition only when a disruption in GI function prevents the introduction, absorption and metabolism, and/or elimination of nutrients and their by-products through the GI tract.

In a study published in the Journal of Pain and Symptom Management a group of scientist assessed the impact of home parenteral nutrition on the quality of life of the cancer patient, changes in nutritional status and evaluated the subjective perception of patient wellbeing.

The study included 370 patients with gastrointestinal cancer. Home parenteral nutrition was indicated for cancer related undernutrition in 89% of these patients. In 84% of these patients parenteral nutrition was used in addition to oral intake for at least 14 days. The physician, the patient and a family member completed questionnaires at inclusion and 28 days later. Quality of life was assessed by the patients using the Functional Assessment of Cancer Therapy-General questionnaire, at inclusion and 28 days later.

Results after 28 days of parenteral intake revealed that the global quality of life improved significantly, patient weight improved, nutritional risk screening decreased as well.

Patients with gastrointestinal cancer are at high risk for deterioration of nutrition and home parenteral nutrition could improve nutritional status and quality of life.

Reference:
A Prospective Observational Study Assessing Home Parenteral Nutrition in Patients With Gastrointestinal Cancer: Benefits for Quality of Life
http://www.jpsmjournal.com/article/S0885-3924(14)00310-8/abstract


Administration of Parenteral Nutrition at home requires the home care nurse completely understand this complex therapy to facilitate safe administration in the home environment.  The nurse should be adept in patient assessment and familiar with central venous access devices.  Lab monitoring will occur on a frequent schedule and the TPN formula may be adjusted based on current lab results. Although rare complications from TPN therapy can arise the complications typically fall into three basic categories; sepsis, mechanical complications of the central venous access device used to administer the nutrition, and metabolic complications from the therapy.

To learn more about Total Parental Nutrition in the Adult Patient take our 5 contact hour online continuing education course. This course may be taken on an individual basis by clicking the course title link or purchased for facility staff by calling 903-871-2150.

Objectives
Upon completion of this course, the participant should be able to:
  • Identify at least three medical conditions that indicate the use of TPN.
  • Identify at least three components of TPN.
  • Demonstrate understanding of TPN administration by recognizing the steps involved in TPN preparation and infusion.
  • Recognize at least two potential complications of TPN.
  • State at least four TPN monitoring measurements.
Curriculum

Chapter 1
  • Indications for Parenteral Nutrition
  • Altered Absorption Capacity
  • GI Disorders Requiring Complete Bowel Rest
  • Intractable Vomiting or Diarrhea
  • Hypermetabolic States
  • Anorexia Nervosa
Chapter 2
  • Goals
  • Maintenance of Normal Body Weight and Protein Status
  • Restoration of Normal Body Weight and Protein Status
  • Maintenance or Restoration of Normal Micronutritional Status
Chapter 3
  • Normal Nutritional Requirements
  • Protein
  • Carbohydrate
  • Lipid
  • Vitamins
  • Minerals
  • Trace elements
Chapter 4
  • Nutritional Assessment
  • Anthropometrics
  • Biochemical
  • Clinical
  • Dietary
Chapter 5
  • Composition of Parenteral Nutrition
  • Dextrose
  • Amino Acids
  • Lipids
  • Water
  • Electrolytes
  • Vitamins
  • Trace Elements
  • Other Additives
Chapter 6
  • Administration
  • Central Venous Access Devices
  • Electronic Infusion Devices
  • TPN and Lipids
  • Preparing the TPN for Infusion
  • Initiating the Infusion
Chapter 7
  • Complications
  • Metabolic Complications
  • Vascular Access Device-Related Complications
Chapter 8
  • Monitoring and Documentation
  • Vital Signs
  • Glucose
  • Weight
  • Intake and Output
  • Laboratory Values
  • TPN Administration
  • IV Catheter Care
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