Summary

Safe and effective administration of home TPN has been accomplished for nearly three decades. Guidelines and other recommendations have improved the outcomes of both survival and health improvement in patients who receive TPN on both a short or a long-term basis. A team approach that combines expertise in the areas of identification of appropriate candidates for TPN in the homecare setting, careful tailoring of both formulations and monitoring protocols to individual needs, and timely resolution of any problems is important to the successful implementation and management of this therapy.

Patients should be metabolically stabilized as much as possible prior to the initiation of home TPN to improve metabolic control. Metabolic complications that occur early in the course of TPN include fluid and electrolyte imbalances, hyperglycemia, and refeeding syndrome. Metabolic complications that may occur later in the course of longer-term TPN include metabolic bone disease, cholestasis, gastrointestinal atrophy and steatosis. Existing conditions, such as significant malnutrition, diabetes, liver or kidney disease, and others can complicate the course of TPN therapy and require additional careful and individualized monitoring efforts. With appropriate care, TPN is a safe and effective method to support nutritional status and health outcomes in the homecare setting.