Clinical complications are one of the greatest concerns in patients requiring long-term HPN support. The most common clinical complication is catheter sepsis with rates ranging from less than 0.8 to more than 2.5 per 1000 catheter days.⁵ The incidence of complications may be related to patient and caregiver training as well as underlying disease (e.g., bone marrow transplant). It has become rare for catheter sepsis to lead to serious setbacks and death in patients, even if dependent on parenteral nutrition support for a number of years.  The more common factor in death for nutrition support patients remains the existing underlying disease. Other complications in the management of parenteral nutrition include electrolyte imbalances, liver and bone abnormalities, and other metabolic alterations. 

In addition to clinical complications psychosocial factors can affect outcomes. These can include reported depression, anxiety, and inadequate training or caregiver support. It is essential to the success of HPN in optimizing quality of life and minimizing psychological barriers, to acknowledge patient concerns and provide information, counseling, support, and connection to resources to overcome these problems.

This journal club will review four recent journal articles that discuss the use, complications, and potential solutions for problems faced by patients treated with long-term home parenteral nutrition.