Addressing the nutritional needs of growing children is imperative for organ development, growth, and energy demands and is one of the reasons children often receive HPN. This intravenous therapy may be comprised of carbohydrates, electrolytes, minerals, proteins, fats, and vitamins. For younger children and infants, inadequate nutrition may keep them from achieving developmental milestones, such as rolling over and walking.

For the administration of HPN, patients with short-term nutritional needs may use a peripheral intravenous line, depending on the recommendation of the attending physician. Patients who have long-term requirements are best served with access through a central venous line. Parents and families are instructed in implementing HPN for the child, which includes care of the entrance site, programming the pump, and connecting the PN bag.

The benefits of home care

Patients can receive parenteral nutrition in the comfort of their own home from an infusion company that coordinates a care plan with their physician and helps monitor patient health. Pediatric Home Service (PHS) specializes in children with medical complexities and provides specialty enteral formulas, tailored PN, lab draws, and nutrition recommendations by PHS’ registered dietitians working with physicians.

The services PHS provides allow these children to thrive at home, in their communities, and participate in day-to-day activities while minimizing exposure to hospital-acquired infections.

HPN requires a team approach

While the physician leads the implementation of nutritional care starting with the initial order for HPN through PHS, successful patient outcomes require communication and coordination with the team. The nutrition support team (NST) at PHS includes infusion nurses, registered dietitians, pharmacists, and referring physicians.

When the patient comes on service:

• Infusion nurses teach the family and child, depending on their age, how to set up and manage the IV and prepare PN for infusion. Older children may be more willing to comply with instructions when empowered to manage their own health care.
• On a weekly basis, a nurse visits the home to record weight, perform lab draws, and review dietary logs including oral, enteral, and parenteral intake. The results of lab testing may impact future compounding of PN.
• A dietitian works closely with the NST to analyze data gathered during the weekly visit and share that information with nurses, patient family members, and the physician.
• If a patient receives HPN from the PHS pharmacy but lives outside the service area of infusion nursing, regional nursing agencies coordinate lab draws that are sent to PHS for review by the NST. Regardless of location, nearly all patients receiving HPN are followed by a PHS dietitian, who will connect with the family on a weekly basis or as frequently as needed.
• Weekly NST meetings allow for the collaborative review of each patient’s labs and data. Team members make recommendations for changing the nutrition plan. Any proposed recommendations are always reviewed with the patient’s physician for approval.
• A PHS pharmacist works with the PHS    dietitian to ensure that the PN recipe is safe and appropriate and communicates with the patient’s physician to determine further recommendations for preparing the PN and monitoring its delivery.