The Serial Studies Of Clinical Application Of Home Enteral Nutrition Support

Background: Home nutrition support is to let those patients who is in a stable situation and need nutrition support receive nutrition support at home.It includes home enteral nutrition(HEN) and home parenteral nutrition(HPN). Parenteral nutrition has some serious complications which are very hard to manage at home in our country today.While as the development of enteral nutrition support techniques and enteral nutrition product,HEN become safe and feasible. Home nutrition support was started in United States in 1970s and the number of patients receiving home nutrition support has progressively increased. Many studies showed that home enteral nutrition can improve and maintain patients'nutrition status,increase the ability of activity,regain everyday life while reduce hospital days and medical cost.There are many disphagic patients because of neurological disorder and intestine disfunction patients who need long-term enteral nutrition support in China.Since there is no organization and service to guarantee their safety,they cann't go home in time.Staying at the hospital would inevitably increase medical cost and prolong hospital stay. Setup related organization to give the necessary service and support to the patients is key to develop HEN in China. In this study, a home nutrition support team was organized and clinical pathways in HEN was institued.All the HEN patients registered in our center were prospectively observed and followed up by the doctor and the nurse of the nutrition team.Imformation for each patient was prospectively recorded by the the nurse of the team. The ways of nutrition support and complications in different diseases were analyzed.At the same time,hospital-stay,medical cost,nutrition status and body compostion of complicated intestine fistula patients were compared between home enteral nutrition and hospital enteral nutrition group. PartⅠThe institution and application of clinical pathway in home enteral nutrition supportAims:To apply clinical pathway in home enteral nutrition support in hospital to standardize and improve patient management in China.Methods:The clinical pathway in home enteral nutrition support was designed by the members of nutrition support team. All registered patients was recorded and followed up by the members of the nutrition support team.Results:A total of 427 patients(283 men,144 women) were registered,Age distribution was 80.3% <65 years.The chife underlying disease was a gut disfunction(58.1%),or advanced cancer(32.5%);Total enteral nutriton were provided in 64.2% patients.A naso-gastric tube(33.7%) or a percutaneous endoscopic gastrostomy/jejumostomy(46.1%) were used to infuse elemental formulars or polymeric formulars.Infusion was cyclical (72.6%)and bolus(20.1%).415 patients were followed up throughout HEN.The duration of HEN was 1-6m(63.9%),more than 2 years(9.6%).The incidence of side-effects was 14.9%,most were minor and enteral nutrition were not interrupted. 110 patients were home visited by the nurse of the nutrition support team regularly according to the clinical pathway.The incidence of lost following up(0.9%), rehospitalization(0.9%) and PEG/PEJ related complication were lower than the telephone-visited 317 patients. HEN duration is 1-6m in 81.5% of gut disfunction patients,a naso-gastric tube was used to infuse elemental or polymeric formulas with most complications were metabolic-related(4.4%). 64.7% of advanced cancer patients died during 1-6m of HEN, 79.1% of the patients took oral diet plus enteral nutrition by PEG with most complications were gastrointestine-related. Most disphagic patient(71.8%)was still on HEN, 28.1% had exceeded 2years.Home-brewed diet were infused or bolus by PEG in All the disphagic patients with most complication were tube-related.Conclusion:Home enteral nutrition can be used safety in gut disfunction patients,advanced cancer patients , disphagic patients and other diseases under the supervise of nutrition support team according to the clinical pathway.Home-visit is more effective than telephone-visit.Different diseases has different feature and need different intervention. PartⅡOutcome of intestine fistula patients treated with home enteral nutrition before definite operationObjectives:The purpose of this study was to assess the outcome of complicate intestine fistula patients treated with home enteral nutriton support before definite operation.Methods:57patients were divided into home enteral nutrition support group and hospital enteral nutrition support group according to their willness when their illness were stable and enteral nutrition were full resumed. Day of home enteral nutrition,day of total enteral nutrion,day of hospital stay and medical cost was recorded prospectively. Plasm protein and body composition of patients were ananlyzed on the first day of full enteral nutriton resumed and the day enteral nutrition was stop for operation preparation.Quality of life(QoL) was assessed through SF-36 at the same time.Results: 31 patients chose receiving enteral nutrition support at home and 27 patient chose hospital .There were no significant difference between two groups at the beginning of enteral nutrition support.The HEN patients had 96.61±28.54 day of enteral nutrition support, 61.11±27.71 days was provided at home.While hospital enteral nutrition patients had a total of 92.04±25.11 days of enteral nutrition support at the hospital.The day of hospital–stay and total medical cost of HEN patients was much lower compared with hospital enteral nutrition support patients.Nutrition status and body composition was improved but no difference between both groups. QoL of all patients were much lower than that of nomal people and improved after enteral nutrition support,while social function and mental health was improved much more in HEN patients than hospital patients.Conclusions: Under the close supervise of nutrition support team, HEN can achieve the same safety and effect ,reduce days of hospital-stay and medical cost,improve social function and mental health comared with hospital EN.SummaryIn the study,a clinical pathway in home enteral nutrition support was instituted in our centre,all HEN patients was closely followed up by the members of nutrition support team.The data of the patients were recorded propectively.We found that home enteral nutrition can be used safety in gut disfunction patients,advanced cancer patients and disphagic patients under the supervise of nutrition support team according to the clinical pathway.Home-visit is more effective than telephone-visit.Different diseases has different feature and need different intervention.Through the observation of outcomes of intestine fistula patients receiving HEN before definite operation, we found that HEN patients can achieve the same safety and effect, reduce days of hospital-stay and medical cost while improve social function and mental health comared with hospital EN patients.