ESPEN Guidelines on Parenteral Nutrition: Home Parenteral Nutrition (HPN) in adult patients

Summary Home parenteral nutrition (HPN) was introduced as a treatment modality in the early 1970s primarily for the treatment of chronic intestinal failure in patients with benign disease. The relatively low morbidity and mortality associated with HPN has encouraged its widespread use in western countries. Thus there is huge clinical experience, but there are still few controlled clinical studies of treatment effects and management of complications. The purpose of these guidelines is to highlight areas of good practice and promote the use of standardized treatment protocols between centers. The guidelines may serve as a framework for development of policies and procedures. Summary of statements: Home Parenteral Nutrition (HPN) in adult patients Subject Recommendations Grade Number Indications Home parenteral nutrition support should be used in patients who cannot meet their nutritional requirement by enteral intake, and who are able to receive therapy outside an acute care setting. B 1.1 Incurable cancer patients may enter a HPN program if they are unable to meet their nutritional requirements by oral or enteral route and there is a risk of death due to malnutrition. It is not a contraindication for HPN that oncologic treatment has been stopped. C 1.2 HPN is not recommended for patients with incurable disease and a short life-expectancy. C 1.3 The nutrition support team in HPN The expertise of a nutrition support team (NST) is recommended for HPN. C 2 Prescription of HPN The electrolyte composition of the HPN regimen should reflect fluid losses. C 3.1.1 The total calories should normally be 20–35 kcal/kg per day. C 3.1.3.1 The non-protein energy provision should be 100–150 kcal for every gram of nitrogen in the HPN. C 3.1.4.1 The unstressed adult HPN patient will require 0.8–1.0 g amino acids/kg per day. For long-term HPN treatment (>6 months) the provision of intravenous lipid should not exceed 1 g/kg per day. Essential fatty acids should be supplied. C 3.1.6.1 The daily requirement for essential fatty acids is 7–10 g, which corresponds to 14–20 g LCT fat from soya oil and 30–40 g LCT fat from olive/soya oil. MCT/LCT and fish oil emulsions also appear safe and effective. Intravenous catheters and devices Tunneled central catheters are used, as permanent access is required for long-term parenteral nutrition. C 4 Implanted ports are an acceptable alternative. PICC-lines are intended for shorter-term use and cannot be recommended for HPN patients. Cyclic adm