Home Parenteral Nutrition

Home parenteral nutrition is a life sustaining therapy for some pediatric and adult patients.

Malnutrition can be a severe consequence of various types of disease. However, not all malnourished patients are hospitalized and not all patients with (or at risk of) malnutrition obtain sufficient nutrition via oral or enteral intake. According to international guidelines, home parenteral nutrition (HPN) should be given to patients who are unable to meet their nutritional requirements via the oral and/or enteral route and who can be safely managed outside of the hospital.¹ For hospitalized patients, transitioning to home can be expedited by fast-track cycling thereby accelerating hospital discharge, decreasing healthcare cost, and improving patient satisfaction.²

ESPEN home parenteral nutrition survey: PN Facts

~1100-1300

kcals/day: Average Energy Provision⁴

~2,000

mL/day: Average Fluid Provision⁴

~30-50%

Average Use of Ready-to-Use PN⁴

Home Parenteral Nutrition is a life sustaining therapy¹

The goal of HPN includes preventing or treating undernutrition and/or dehydration, helping a patient become fit for surgery, reducing gastrointestinal symptoms like diarrhea or vomiting, reducing abdominal pain caused by oral or enteral feeding and improving the quality of life.³

The use of HPN therapy can be relevant in four different clinical scenarios:

Chronic Intestinal Failure due to benign disease

HPN is the primary life-saving therapy for patients with chronic intestinal failure (CIF) due to benign disease such as short bowel, intestinal fistulas, dysmotility or mechanical occlusion or extensive small bowel mucosa disease.^1,5

Chronic Intestinal Failure due to malignant disease

HPN is often used temporarily during curative treatments in patients with CIF due to malignant disease.¹

Prevent or treat malnutrition

To prevent or treat malnutrition, HPN can be given to patients with a functioning intestine who decline other types of medical nutrition.¹

Supportive care

HPN is a part of supportive care for patients with incurable malignant disease and is provided to avoid death from malnutrition.¹

Ready-to-use HPN solutions are recommended by international guidelines

ESPEN guidelines recommend either commercially available ready-to-use solutions or customized solutions for HPN patients.¹ While customized HPN solutions can be used, international guidelines also recommend ready-to-use products like two-chamber bag (2CB) or three-chamber bag (3CB) solutions as these have advantages in terms of longer shelf-life, ease of use, portability and good stability at room temperature.¹ Baxter offers a broad range of ready-to-use multi-chamber bags to meet the unique protein and energy needs of neonatal, pediatric and adult patients.

Learn more about Home Parenteral Nutrition

Learn about ESPEN guidelines on HPN for adults and ESPGHAN/ESPEN/ESPR/CSPEN guidelines on HPN for children

Adult guidelines Pediatric guidelines

Licensed ready-to-use PN solutions for HPN

See References

Pironi L et al. ESPEN guideline on home parenteral nutrition. Clin Nutr. 2020 Jun;39(6):1645-1666.
Austhof S, et al. Expediting Transition to Home Parenteral Nutrition With Fast-Track Cycling. JPEN 2017;41(3):446-454.
BAPEN (the British Association for Parenteral and Enteral Nutrition) website. Home Parenteral Nutrition. Accessed July 2021. https://www.bapen.org.uk/nutrition-support/parenteral-nutrition/home-parenteral-nutrition
Pironi L et al. Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients: An international survey. Clinical Nutrition 39 (2020) 585e591
Pironi L et al. Home artiﬁcial nutrition & chronic intestinal failure; acute intestinal failure special interest groups of ESPEN. ESPEN endorsed recommendations. Deﬁnition and classiﬁcation of intestinal failure in adults. Clin Nutr 2015;34:171e80.