A0638 - Management of Home Parenteral Nutrition in Gastroenterology Office Infusion Centers

Timothy E. Ritter, MD¹, Dawn N. Kim-Romo, PharmD, PhD², Claudia Schroeder, PharmD, PhD², Lucinda J. Van Anglen, PharmD^2
1GI Alliance, Southlake, TX; ²Healix Infusion Therapy, LLC, Sugar Land, TX

Introduction: Home parenteral nutrition (PN) is commonly provided to patients (pts) with gastrointestinal dysfunction. There remains a lack of data on the provision of PN through gastroenterology (GI) office infusion centers (OICs). We evaluated the management of pts in this setting.

Methods: A retrospective study was conducted in pts receiving PN through GI OICs over a 6-year period. Pts were selected for PN therapy by their gastroenterologist. The physician and PN-trained pharmacist managed the PN formula. PN-trained nurses performed pt teaching, drew weekly labs, and provide catheter care in the OIC. All pts self-administered PN with solution and supplies dispensed weekly from the pharmacy. Data included demographics, PN indications, comorbidities, nutritional status, PN regimen, and home vs. hospital PN initiation. Pt weight (wt) changes were assessed, and catheter-related blood stream infections (CRBSI) occurring during PN therapy were measured. Descriptive statistics were utilized.

Results: A total of 17 PN pts (71% female) were identified with a mean (SD) age of 44 (17) years. PN was initiated in the OIC in 8 pts (47%). Indications for PN included severe malnutrition/malabsorption (n=6), small bowel obstruction (n=4), intestinal motility disorder (n=4), GI fistula (n=2), and short bowel syndrome (n=1). Underlying disease included inflammatory bowel disease (IBD) in 8 pts (47%) and malignant disease in 3 pts (18%). Most (76%) were on a limited oral diet as tolerated. The median [IQR] duration of PN therapy was 10.3 [1-21] months, and 10 pts (59%) received >3 months of therapy. All pts received cyclic PN with protein, carbohydrate, and fat. Mean (SD) caloric intake of PN was 28 (6) kcal/kg/day and was administered over 9-18 hours. Stable or improved wt changes were reported in 14 pts (82%) at a median [IQR] increase of 4.5 [1-7] kg. Three pts experienced declining wt (2 malignant disease, 1 uncontrolled IBD). The CRBSI rate was 0.81% per 1000 days, which was lower than the previously reported rates in adults of 3.1% and 4.58% per 1000 days.

Discussion: The GI OICs provide collaborative care settings for the management of PN using trained nurses, pharmacists, and readily accessible gastroenterologists. PN was successfully initiated in the home setting in almost half of study pts. Positive weight changes were recorded in 82% of pts, and there was a lower rate of catheter infections compared to reported rates with traditional home care. GI OICs offer safe and effective provision of home PN.


Disclosures:


Timothy E. Ritter, MD¹, Dawn N. Kim-Romo, PharmD, PhD², Claudia Schroeder, PharmD, PhD², Lucinda J. Van Anglen, PharmD². A0638 - Management of Home Parenteral Nutrition in Gastroenterology Office Infusion Centers, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.