Education may help prevent infection from parenteral nutrition

For many cancer patients who are unable to eat food by mouth, giving life-sustaining nutrients by injection is essential to the treatment and recovery process, especially after patients are discharged from the hospital. However, this important component of home care, commonly called total parenteral nutrition at home, has come into disrepute, mainly due to the high incidence of catheter-associated infections.

But new research suggests that many of these infections can be avoided by developing a standardized protocol and properly educating patients on how to follow it. A study I conducted found that cancer patients who received detailed instructions from a team of doctors before they were discharged from hospital developed fewer catheter-related bloodstream infections. The 241 participants were adult cancer patients who received treatment at a Chicago area hospital and were prescribed home treatment with TPN. The study was conducted over a period of two years, from January 1, 2012 to December 31, 2013. Because the immune systems of cancer patients are often compromised, they are especially vulnerable to infections in the bloodstream when receiving catheter feeding or therapy. . Infection can have a devastating effect, making prevention important to a patient’s recovery.

Each patient in our study followed the same standard process that:

• He initially received an injection in the hospital for two days.
• They received detailed verbal instructions from a team of nurses, dieticians and a dedicated case manager while in the hospital.
• They watched an educational DVD about the TPN procedure during the hospital infusion and were able to ask any and all questions from their care team.
• She discussed all the steps involved with her care team before going home, from properly refrigerating the TPN bags and keeping them away from other foods, to adding the correct combination of nutrients and hand washing after handling the bags.
• He came home with a DVD and supporting learning materials for their reference at their convenience.
• They were visited for the first few days at home by a home care nurse, who helped them through the process and made sure they were doing it properly.

Our study, which we presented in February at the American Society of Parenteral Nutrition and Clinical Nutrition Week Education and Research Conference, found that patients had a catheter-based infection rate of 0.47 per 1,000 catheter days. This compares to a 1999 study that found the incidence rate in patients with a variety of diseases, including HIV and cancer, to be between 0.16 and 6.77 per 1,000 catheter days, depending on the number of risk factors involved. Another 2006 study found that up to 63 percent of patients who take TPN at home develop at least one catheter-based infection per year.

The results are particularly important for cancer patients. During their care, they are more likely to suffer from malnutrition, which can lead to complications and quality of life problems. The more confident oncologists have in your TPN plan, the more likely they are to prescribe it. Standardizing that plan and engaging patients in a comprehensive learning process are two important steps to giving them the nutrients and independence they need for the battle ahead.

Learn more about how cancer patients can fight malnutrition.