Mayo Home Parenteral Nutrition Service

By Mayo Clinic Staff

Team Members:
Physician (Program Coordinator): James Scolapio, M.D., 904-953-7060.
Dietitian:Vilia Tarrosa, M.S., R.D., L.D., 904-296-3733.
Pharmacist: Gary Stoner, R.Ph., 904-296-3770.

What is home parenteral nutrition?
Normal digestion and absorption of food occurs through the gastrointestinal (GI) tract. If the GI tract cannot be used because of disease or other medical conditions, a person may receive nutrition through the bloodstream. This is called parenteral nutrition. When it is done at home it is called home parenteral nutrition or HPN.

Who may need HPN?
The most common conditions which can prevent normal digestion of food by the GI tract include inflammatory bowel disease (Crohn's disease), surgical bowel removal (short bowel syndrome), and abnormal bowel function (motility problems due to surgical adhesions, radiation enteritis, neurological disorders, and other conditions).

The goal of HPN is to correct or prevent malnutrition. The need for HPN may be for a few months or for the rest of one's life.

The HPN Team
HPN consumers have complex health-care needs. Members of the HPN team are available to evaluate, educate, and manage those needing HPN.

HPN Physician — A gastroenterologist with special training in nutrition. This physician supervises your training, handles inquiries regarding medical aspects of your nutritional program, monitors and adjusts your nutritional program as indicated by your progress, and periodically works with your home physician.

HPN Dietitian — A registered dietitian facilitates the coordination of your care. This dietitian coordinates your inpatient and outpatient visits, monitors your laboratory values and response to home care, and manages the communication between you, the HPN team, and the home care company. The HPN dietitian works closely with all team members and is available to respond to your questions and concerns.

HPN Pharmacist — A clinical pharmacist who works with you to help you understand the use of drugs and nutrients. The pharmacist contacts the home care company to arrange for supplies to be delivered to you, monitors your laboratory values and coordinates changes in your TPN formula with a physician.

HPN Nurse Educator — Registered nurses specially trained in teaching HPN. An HPN nurse educator will be assigned to work with you during the training period.

Social Worker — A person who interviews you to obtain a social and financial history for the HPN team. This helps determine how your life might be affected by HPN. HPN is an expensive form of treatment, and few people are financially able to manage it alone. The social worker can suggest potential financial and community resources.

Surgeon — A physician who inserts and if necessary removes the HPN catheter.

Home Care Company — The company that provides you with HPN supplies and clinical services also communicates closely with a physician. The HPN team helps you select a home care company.

Catheter Selection — Two types of catheters can be used for receiving HPN. The catheter most commonly used is a soft, silicone tube with a segment exiting the chest. The other catheter is an implantable venous access device or port. Both catheters are inserted into a large vein going into the heart. This allows the nutrition solution to be delivered to a rapid-flowing vein. The HPN team will help you determine which type of catheter best meets your needs.

HPN Teaching Program — HPN training is designed to help you develop skills and an understanding of:

  • The catheter
  • The aseptic (sterile) techniques necessary for safe HPN procedures
  • The HPN equipment and procedures
  • Precautions to prevent and deal with complications

After completing the HPN training and before leaving a supervised setting, you or a person caring for you must be able to do the HPN procedures alone with the help of a training manual.

Follow-up — To allow smooth transition from the training site to home, the HPN team will evaluate and help arrange your home supply needs. Your follow-up care will be maintained through telephone and mail contact.

Factors to Consider — Several factors are considered before deciding that HPN is the appropriate medical treatment. The HPN team will evaluate medical, emotional, financial, and functional capabilities of you and your family before determining if home parenteral nutrition meets your needs.