Importance of Home Parenteral Therapy: ESPEN Recommendations from 2020

Introduction

Home parenteral therapy represents a life-saving treatment modality for patients with chronic intestinal failure due to benign or malignant diseases. It is also a part of palliative care for incurable malignancies to prevent death due to malnutrition. Additionally, it may be indicated for patients with functional intestines who refuse other types of nutrition.

The recently published ESPEN guidelines, consisting of 71 recommendations, discuss the issues of indications, safe administration, and clinical monitoring. Much of the recommendations are based on strong evidence and majority expert consensus.

Significance of Home Parenteral Therapy

According to current recommendations, home parenteral therapy should be administered to patients for whom oral or enteral nutritional requirements cannot be met and who can safely receive parenteral therapy outside a hospital setting. It should be implemented as a primary life-saving treatment modality for patients with transient or permanent chronic intestinal failure due to non-malignant disease and considered for those with chronic intestinal failure due to malignant disease.

For patients with advanced malignant disease and chronic intestinal failure, it should be used to prevent premature death due to malnutrition when the expected lifespan exceeds 3 months, even for those not undergoing active oncological treatment.

For patients without chronic intestinal failure who cannot achieve adequate nutrition through oral or enteral routes, home parenteral therapy should be considered. These patients should be clearly informed of the benefits and risks associated with this modality.

Regarding therapy safety, it is recommended that patients be metabolically stable outside the hospital environment. Home parenteral therapy should be administered using infusion pumps for safety and treatment effectiveness. The new guidelines include several points on asepsis and disinfection to enhance therapy safety. One recommendation is the individualization of therapy to cater to specific nutritional needs.

Conclusion

The current guidelines from the European Society for Clinical Nutrition and Metabolism highlight the importance of home parenteral therapy for specific patient groups and provide numerous recommendations for increasing the effectiveness and safety of parenteral therapy.

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Source: Pironi L., Boeykens K., Bozzetti F. ESPEN guideline on home parenteral nutrition. Clin Nutr 2020 Jun; 39 (6): 1645–1666, doi: 10.1016/j.clnu.2020.03.005.