Treatment at Mayo Clinic

By Mayo Clinic Staff

Specially trained health care providers show you and your caregivers how to prepare, administer and monitor PN at home. Your feeding cycle is usually adjusted so that PN infuses overnight, freeing you from the pump during the day. Portable pumps are available for those who need daytime infusion. Some people report a quality of life on PN similar to that of receiving dialysis.

Your PN care team may include:

  • Doctors. A surgeon will insert and, if necessary, remove the intravenous catheter used to infuse the PN. A gastroenterologist with special training in nutrition will supervise the medical aspects of your home PN and coordinate treatment with your primary care provider.
  • Nurses. Nurses will include a coordinator, a nurse educator who will train you to take care of your intravenous catheter, and staff nurses who are always available to answer questions and provide support.
  • Pharmacist. A clinical pharmacist will help you understand the use of drugs and nutrients, including the PN. The pharmacist contacts the home care company to arrange for you to receive supplies.
  • Dietitian. A registered dietitian will help you understand your diet and assist in planning appealing meals and snacks. If you need a special dietary product, the dietitian will advise you about its preparation, consumption, cost and availability.
  • Social worker. A social worker will obtain a social and financial history for your home PN team. Home PN is expensive, and many people need financial assistance. The social worker can suggest potential financial and community resources.
  • Home care company. A home care company will provide you with supplies, including the PN and clinical services. Your team helps you select a home care company.

You will have follow-up exams to assess your PN plan.

Depending on your reason for using PN, at some point your care team may help you decrease the amount you need. In some cases, your team will help to wean you off of PN entirely. Researchers at Mayo Clinic and elsewhere are studying both nutrients and drugs to help decrease the need for long-term PN.

Catheter types

PN is delivered through a thin, flexible tube (catheter) that has been inserted into a vein. At Mayo Clinic, doctors with special training in nutrition work with you to determine the type of catheter that's best for you. Mayo offers two main catheter options for delivering PN:

  • A tunneled catheter, such as a Hickman catheter, has a segment of tube outside the skin and another portion tunneled under the skin before it enters the vein.
  • An implanted catheter is inserted completely beneath the skin and needs to be accessed with a needle in order to infuse the PN.

Both types of catheter are usually inserted into a large vein leading to the heart. PN through this large vein can deliver nutrients quickly and lower the risk of catheter infection. The catheter insertion procedure is usually done after you've received heavy sedation or anesthesia.

Complications

Catheter infection is a common and serious complication of PN. Other potential short-term complications of PN include blood clots, fluid and mineral imbalances, and problems with blood sugar metabolism. Long-term complications may include too much or too little of trace elements, such as iron or zinc, and the development of liver disease. Your Mayo treatment team will monitor your PN formula closely and institute procedures to help prevent or treat these complications if already present.

Your team will use laboratory testing to monitor your responses to PN. They will also periodically evaluate your fluid balance, the catheter site, and your ability to switch to tube feeding or normal oral feeding.

Oct. 28, 2014