LB056 - CHALLENGES IN ESTABLISHING AN OUTPATIENT CLINIC FOR HOME PARENTERAL NUTRITION AT A UNIVERSITY MEDICAL CENTER

LB056

CHALLENGES IN ESTABLISHING AN OUTPATIENT CLINIC FOR HOME PARENTERAL NUTRITION AT A UNIVERSITY MEDICAL CENTER

A. Ocepek1, M. Šeruga2, M. Horvat3, U. Gajšek3, C. Velkovski1, M. Koler Huzjak4, T. Pečko4,*, J. Privšek4, L. Dobaj4, T. Šimac1, U. Vernik3, A. Šolar2

1Department of gastroenterology, University division of internal medicine, 2Department of oncology, Unit for palliative care, 3University department of abdominal and general surgery, University division of surgery, 4Clinical dietitians, Healthcare services, University Medical Centre Maribor, Maribor, Slovenia

 

Rationale: Home parenteral nutrition (HPN) is a life-saving therapy for patients with intestinal failure who cannot meet nutritional needs enterally or orally. Although ESPEN guidelines provide detailed recommendations, outpatient implementation remains challenging.

Methods: We conducted a retrospective analysis of 10 patients receiving HPN between January 2023 and May 2025 to identify key barriers in establishing an outpatient HPN clinic.

Results: The cohort included 10 patients (5 female), with a mean age of 46.6 years (range 45–82). Intestinal failure was malignancy-related in 5 patients (gastric, pancreatic, colorectal cancer, cholangiocarcinoma) and due to benign causes in 5 (e.g., complicated acute pancreatitis, duodenal perforation, ischemic bowel, short bowel syndrome, and small bowel vasculitis). All cases were managed by a multidisciplinary team. We identified five major implementation challenges:

        1. Clinic Structure & Policy Alignment: ESPEN recommends dedicated HPN centres. We structured a unit within the gastroenterology department, but lack of centralized infrastructure, staffing, and funding limited functionality.

        2. Multidisciplinary Team Coordination:
Recruiting and coordinating an NST was difficult due to cross-departmental distribution, though expert commitment enabled continuity of care.

        3. Training Program Implementation:
Three nurses were trained to educate patients in catheter care, pump use, and complication management, though departmental dispersion affected scheduling and continuity.

        4. Logistics & Supply Chain:
Pharmacy delays and the absence of a national delivery system required patients to self-manage transport and storage of supplies.

        5. Monitoring & Escalation Pathways:
Regular outpatient monitoring, infection prevention, and emergency response protocols proved difficult to coordinate across departments.

Conclusion: A significant gap exists between ESPEN recommendations and real-world outpatient HPN implementation. Key requirements for successful integration include institutional recognition as an HPN centre, coordinated staffing, structured training, reliable logistics, and clearly defined emergency protocols.

References:         1. Pironi L, Boeykens K, Bozzetti F, et al. ESPEN practical guideline: Home parenteral nutrition. Clinical Nutrition. 2023;42(5):987‑1024.  

        2. Pironi L, Arends J, Baxter J, et al. Operational recommendations for the implementation of home parenteral nutrition in chronic intestinal failure. Clinical Nutrition ESPEN. 2024; [op. cit.]  

        3. Pironi L, Bozzetti F, Joly F, et al. ESPEN guideline on home parenteral nutrition. Clinical Nutrition. 2020;39(6):1645‑1666.  

        4. Pironi L, Arends J, Bozzetti F, et al. ESPEN guideline on chronic intestinal failure in adults, update 2023. Clinical Nutrition. 2023;…  

        5. Slye K, et al. A comparison of a home parenteral nutrition service with current ESPEN guidelines on chronic intestinal failure in adults. Clinical Nutrition ESPEN. 2022.  

        6. White Paper, Medical Nutrition Industry. Factors contributing to unequal access to home parenteral nutrition in Europe. 2023.  

        7. Joly F, Pironi L, et al. Considerations for the management of home parenteral nutrition during the SARS‑CoV‑2 pandemic. Clinical Nutrition. 2020;…  

        8. Staun M, Pironi L, Bozzetti F, et al. ESPEN Guidelines on parenteral nutrition: catheter access, care, diagnosis of complications. Clinical Nutrition. 2009;28(4):465‑479.  

        9. Wengler A, Micklewright A, Hebuterne X, et al. Monitoring of patients on home parenteral nutrition in Europe: a questionnaire‑based study on monitoring practice in 42 centres. Clinical Nutrition. 2006;25(4):693‑700.  

        10. Kumpf VJ, Herman JH. Home parenteral nutrition: quality‑of‑life and clinic support challenges. ASPEN Journals. 2012.  

Disclosure of Interest: None declared