Managing adult patients who need home parenteral nutrition

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.