Purpose:

1
An Experience on Helping Families Learn Home
Parenteral Nutrition
Shu-Yi TSENG1,2 ?Shu-Ling TU2
1TPN
Team 2Changhua Christian Hospital, Nursing
Department, Changhua city, Taiwan
Purpose Short bowel syndrome (SBS) is a disorder
caused by the surgical removal of large part of
intestine due to congenital or acquired factors.
The gastric emptying rate increases and patients
with SBS often have diarrhea. The bowel
dysfuction results in complications, such as
malabsorption, and full pulse nutrution is
required. After patients stay stable, they need
to learn how to perform home parenteral
nutrition, which brings pressure to them and
their families. The purpose of this study is to
explore the problems and pressure the familiy
members of a patient with SBS faced while
learning home parenteral nutrition, and how the
medical team provided resources
and assistance. Design The subject of this
study is a premature baby born at 33 weeks and 5
days on Oct. 8, 2012, weighing 3208g. Bowel
resection was conducted and about 30 cm of
jejunum was left due to meconium peritonitis and
congenital jejunal atresia. The case was
diagosed as congenital short bowel syndrome.
Observation, interviews and direct care were
performed for an holistic evaluation from Jan.6,
2013 to March 11, 2013 by the researcher. Home
parenteral nutrition education was provided to
the family members. The disease progression was
shown in figure 1. Figure 1 Medical
Procedure  During hospitalization (from Oct. 8,
2012 to Mar. 11,2013), the subject was provided
with calories 115 kcal / kg / day and protein 3g
/ kg / day. After discharge, intravenous
nutrition calories 43 kcal / kg / day and enteral
nutrition semielemental formula 77 kcal / kg /
day were provided. 10/08/12- jejumal atresia
diagnosed, segment resection with end to end
anastomosis performed 10/09/12- TPN team
consultation, nutritional assessment, daily
demand 115kcl / kg / day, Protein3g / kg /
day 10/28/12- tried breast-feeding 01/06/13-
prepared HPN, Brovtac insection (Hickmun)
catheter placed 02/19/13- start HPN preparation
and health education, Cycled PN
executed 02/28/13- Cycled PN 18hrs, stop 6hrs,
returned demonstration 03/12/13- home parenteral
nutrition after discharge, BW 4.6kg,
semielemental formula 6 meals / day, 85? per
meal 03/26/13- milk 100-120cc 6 meals 04/13/13-
home visits 05/27/13- catheter obstruction
removed, intravenous nutrition 76 days, started
full enteral nutrition 06/25/13- BW 6.6kg, milk
150-160cc 5 meal, non-staple foods added,
completely out of parenteral nutrition Method In
travenous nutrition was provided to this case
during hospitalization. While explaining
intravenous nutrition-related issues to the
family, it was found that the family had
difficulty in performing home parenteral
nutrition due to heavy daily work and financial
problems. The medical team succeeded in inviting
the family to be part of the caring plan and
provide medical resources and consultation (Table
1). The case was discharged for home parenteral
nutrition on March 12, 2013. Res
ults Through telephone interviews and home
visits, the subjects father was observed to
prepare and operate pump correctly. The medical
wastes were classified and stored properly.
Medications were strored correctly and documented
in details. The calorie intake of the case
reached 110kcal / kg / day (Figure 2), enteral
nutrition was increasing gradually, and
parenteral nutrition calorie was reduced. Home
parenteral nutrition ended because of catheter
occlusion on May 27, 2013. Completely oral
feeding was suggested. The protein intake
reached 2g/kg/day (Figure 3) and the weight was
increasing (Figure 4). Through telephone
interviews with the father, the
subjects condition was acceptable. The case was
energetic, yet showed developmental delay. The
family was satisfied with the outcome.

Table I Nursing Care
Home care problem Related Factors Care Management   Care Valuation  
1? Economic distress 2?stress of the caregiver   1-1 Mortgage and economic crisis   2-1 caregivers were under stress to learln how to operate parenteral nutrition devices, sterilize catherer and related works 2-2. caregivers needed to re-adjust to a new life schedule and faced more problems   Social worker Assisted and provided rescources Dietitiansprovided health education and found rescources or alternative formula to use TPN nurseprovided home care guidance, including cognitive aspect preparation supplies, fever and catheter occlusion management, outpatient medication and consultation due to abnormal discomfort, emergency contact number. (2)skills correct hand washing procedure, the central catheter replacement, infusion tube exhaust, the correct instrument installation, instrument operation to switch off warning signal, drug pumping, return demonstration, and enhance care skills. Home care nursesregular home visits, helped caregivers to reduce stress and provided positive feedback, increased caregiversconfidence   Caregivers unstood the caring plans, adjusted to the new situation, and performed home parenteral nutrition after discharge.  
Figure 2 home parenteral nutrition intake
Figure 3 Protein intake during the home
parenteral nutrition
Figure 4 Weight change during home parenteral
nutrition