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Guidelines for sites linking to mayoclinic.orgTPN Team | Catheter Selection | Home Teaching Program | Complications
The following members of the home TPN team evaluate, educate and manage the complex health care needs of TPN patients:
Physicians – A gastroenterologist with special training in nutrition supervises training, handles inquiries regarding medical aspects of the nutritional program, monitors and adjusts the nutritional program as indicated by the patient's progress, and periodically works with the home physician. An interventional radiologist or surgeon inserts and, if necessary, removes the TPN catheter.
Mid-level provider – A physician's assistant or nurse practitioner works with the TPN physician to help manage care.
Nurse coordinator – This nurse is the major contact to patients at home. The nurse works with the physician and mid-level provider to optimally manage nutrition in the home setting.
Pharmacist – A clinical pharmacist helps the patient understand the use of drugs and nutrients. The pharmacist contacts the home care company to arrange for supplies to be delivered, monitors laboratory results and coordinates changes in the patient's TPN formula with a physician.
Nurse educator – Registered nurses specially trained in teaching TPN work with the patient during the training period.
Social worker – Mayo Clinic social workers interview the patient to obtain social and financial history. This information helps determine how TPN might affect the patient's life. Home TPN is an expensive treatment, and few people can financially manage the cost alone. The social worker identifies potential financial and community resources to help.
Dietitian – A dietitian coordinates inpatient and outpatient visits, monitors the patient's laboratory test results and response to home care, and manages the communication between the patient, the care team, and the home care company. The home TPN dietitian works closely with all team members and is available to respond to patients' questions and concerns.
Home care company – The company that provides the patient with TPN supplies and services, and also works closely with a physician. The care team helps to select a home care company.
Hickman catheter
Two types of intravenous catheters can be used for receiving long-term home TPN. The Hickman catheter is most commonly used. It is a soft, silicone tube with a segment exiting the chest. The other catheter is an implantable venous access device or port which is completely under the skin. Both catheters are inserted into a large vein going into the heart. These catheters are put in place while the patient is under heavy sedation or anesthesia in the operating room or radiology suite. These catheters allow the nutrition solution to be delivered to a large, rapidly flowing vein. The care team will help determine which type of catheter best meets the patient's needs.
TPN training occurs while the patient is at Mayo Clinic. The training helps the patient develop skills and an understanding of:
After completing the TPN training and before leaving a supervised setting, the patient or a caregiver must be able to perform the TPN procedures alone, with the help of a training manual. Follow-up care will be maintained through regular telephone and mail contact.
Many patients on home TPN experience complications, including the possiblility of catheter infections, liver disease, bone disease and clotting of the large veins where the catheters are placed. Physicians who specialize in intestinal failure can recommend how the TPN formula or procedures can be changed to avoid or treat these complications.
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