Clinical Research

In order to improve the quality of life of nutrition consumers, we believe in nourishing industry advances in TPN and tube feeding through constant research and innovation.

For clinical resources categorized by Disease, Access, Practice, Symptom and Complications Management, view our Online Clinical Resource Guide. Samples of our published clinical research can also be found below, by topic and year.

Summary: The growing social consciousness to protect natural resources has driven many states to address initiatives that divert and limit waste contribution to landfills. With a focus on how to limit the volume and toxicity of the waste generated by home healthcare, this poster seeks to create awareness about the amount of waste contributed to local landfills by home TPN infusion therapy, and suggests approaches to minimize the negative ecological impact.
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Summary: Limited data exists on the home care tube feeding patient population. Healthcare professionals may not always be aware that receiving tube feeding in the home is a viable option for many patients compared to a protracted admission in an acute care, rehabilitation facility or a nursing home. Apria Healthcare analyzed patient demographics and utilization data to evaluate prescription practices across the United States.
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Summary: Successful management of pediatric short bowel syndrome (SBS) requires skilled orchestration of an array of medical, surgical and paramedical services. This case study highlights the complex interactions necessary between a Pediatric Nutrition Support Team (NST) at a major pediatric teaching hospital, and a Home NST from Coram Specialty Infusion culminating in a positive pediatric outcome.
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Summary: Providing appropriate care for patients on specialized nutrition support in the home is challenging, but even more so when the patient lives in a rural community with limited medical or nutritional resources. Optimally when a patient is discharged on enteral feedings, they should receive education, support and follow up to ensure they will be successful at home. In a rural community, it is often left up to the local home health agency and/or physician who may not be very familiar or comfortable with the art and science of home tube feedings. This case study outlines the partnership between Apria Healthcare and a home health agency to coordinate care, provide patient and family education and assure therapy compliance, ultimately resulting in a positive patient outcome.
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Summary: Providing parenteral nutrition (PN) in the home can present different challenges than providing it in the hospital or in a long-term care facility. To ensure the provision of a safe and stable PN solution for use in the home, an electronic PN order form with an integrated assessment guide was introduced. The form was designed to enable the clinician to evaluate the PN formula order using accepted literature guidelines for extended stability and safe administration.
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Summary: Registered Dietitians (RD) working in private practice or in a clinic setting may be faced with the need to refer a patient to a home infusion provider to provide enteral (EN) or parenteral nutrition (PN). The patient's managing physician may have limited experience and education regarding the management of nutrition support patients at home, and generally do not discern between home infusion companies' expertise in Home Parenteral and Enteral Nutrition (HPEN) patient management. The private practice RD has a unique and important role in understanding the capabilities of the available HPEN providers and educating both the managing physician and patient as to their best options for care. Questions to identify the optimal home infusion provider and resources for the private practice RD are included.
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Summary: Vitamin D has become a hot topic in the world of nutrition because of the emerging science which suggests that vitamin D has pleiotropic effects in a variety of extraskeletal tissues that are important in health and prevention of disease. This poster investigates the role of vitamin D in patients receiving home parenteral nutrition and seeks to determine if oral vitamin D supplementation is sufficient to reach normal serum levels in HPN patients in lieu of an available IV form.
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Summary: Central vascular access device (CVAD) infections can have a deleterious effect on the successful delivery of infusion therapy, leading to significant morbidity and mortality and increased medical costs. Although CVAD infection rates are often lower in the home infusion population than the hospital population, they remain a persistent issue and are one of the leading causes for rehospitalization in the home care patient. Parenteral nutrition (PN) patients experience higher CVAD infection rates than their non-PN counterparts. Differentiation between these two populations when reporting home CVAD outcomes will create opportunities for identifying improved protocols for risk reduction.
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Summary: Patients who receive home parenteral nutrition (HPN) often receive a dextrose infusion of 300 grams or greater daily as part of the overall nutrient containing solution. As there is an established clear benefit of glucose lowering to prevent or retard the progression of microvascular complications (retinopathy, neuropathy and nephropathy) and cardiovascular disease associated with the prediabetic state in individuals who do not receive HPN, glucose tolerance was evaluated in a long-term patient receiving HPN.
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Summary: Synergy between the Metabolic Service, caregiver and Home Nutrition Support Team (HNST) is pivotal in providing optimal nutritional management of consumers, with complex metabolic alterations, who require long-term specialized nutrition support. This poster follows a young male with Barth Syndrome (BTHS) a rare, x-linked mitochondrial disorder. Throughout the growth continuum there are numerous nutritional concerns that arise, and careful dietary monitoring is the only way to ensure proper caloric and nutritional intake.
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Summary: One of the most serious complications of Home Parenteral Nutrition is catheter related sepsis.  This study evaluated if initiating a protocol for catheter hub anti-sepsis along with the use of an intravenous disinfection cap that would provide sustained antiseptic contact would reduce the incidence of catheter related infections in PN and multilumen central venous catheter patients. Although the sample size is small, the findings demonstrate significantly reduced catheter infection rates with the disinfection cap, which warrants the undertaking of a larger, randomized controlled trial that will occur later in 2011.
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Summary: One of the most serious complications of home parenteral nutrition (HPN) is a catheter- related blood stream infection (CRBSI). Patient care and safety are key concerns as a central line infection or blockage may be life threatening or devastating if the line must be removed, resulting in lack of access for nutrition and potentially a loss of venous access sites. CRBSI and its associated sequelae may be decreased or avoided with proper clinician and patient education. Policies and procedures as well as standards of care on avoidance of CRBSI are not consistent among providers.
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Summary: ORS can be useful in an intestinal rehabilitation program as well as an ongoing adjunct in treatment for short bowel syndrome (SBS). Most patients who have increased output and require fluid supplementation have SBS or a similar diagnosis that causes increased gastrointestinal (GI) losses, and many depend on home parenteral nutrition (PN). However, advances in drug therapy, medical nutrition therapy and clinical care have led to increased utilization of specialized diet and fluid interventions to reduce dependence on home PN.
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Summary: Patient-centered outcomes have been identified as the primary means of measuring the effectiveness of healthcare delivery. It is acknowledged that patients' reports of their satisfaction with the quality of care and services are as important as many clinical health measures. Routine measurement of patient satisfaction (PS) for a variety of care indicators is fundamental in the assurance of quality care provisions, and the scrutiny of data validity is essential to accurately reflect the care delivered. This underscores the need for organizations to systematically collect reliable and unbiased PS information from their own patients on an ongoing basis. One large, national home infusion company performs continuous measurement of PS with all key aspects of infusion service to identify service effectiveness and opportunities to enhance satisfaction.
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Summary: Short bowel syndrome (SBS) is an uncommon condition that occurs when less than 200 centimeters of small bowel (SB) remain after small bowel injury and resection. Fecal energy loss is the result of malabsorption of nutrients by the remaining SB. There is remarkable variation in the efficiency of SB mucosal cells to adapt to SBS. Controversy exists over the efficacy of medical management in patients with SBS and intestinal failure. We present the case of a 44-year-old woman on oral contraceptives with undiagnosed anti-phospholipid syndrome and massive SB infarction, who, despite having 40 centimeters of small bowel remaining after a SB resection, responded to an aggressive management plan including temporary total parenteral nutrition (TPN) and enteral alimentation.
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Summary: Healthcare reform is a major issue in the United States. Hospital admissions and healthcare dollars are being closely scrutinized. Initiating parenteral nutrition (PN) in the home care setting versus an acute care center in carefully selected, appropriate patients will avoid hospitalization and therefore avoid a costly hospital admission.
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Summary: One national home parenteral nutrition (HPN) provider has previously published outcomes of patients receiving HPN, and now presents data reaching from 1997 to 2005 and 2007 to 2008 to evaluate if patient demographic shifts can be noted. The data comes from both long- and short–term HPN patients (<30 days to >30 years) referred from multiple clinical settings, including private practice and tertiary medical centers. The average data and the data for all three sub-groups analyzed represent statistically significant HPN patient populations across the United States, allowing for a trended view of demographic changes over time.
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Summary: This study reviews the development and implementation of an electronic nutrition assessment tool for Home Parenteral Nutrition (HPN) patient management and communication.
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Summary: This study reviews the importance of an emergency preparedness plan that takes into account the special needs of the home tube feeding patient.
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Summary: The objective of this study is to identify the prevalence and need of parenteral nutrition (PN) post-bariatric surgery for one national home infusion company, and to also identify the role of the registered dietitian (RD) in managing PN for post-bariatric surgery patients.
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Summary: Radiation Enteritis (RE) is defined as an inflammation of the lining of the small and large intestines resulting from radiation to treat cancers of the abdomen, pelvis or rectum. This case study demonstrates how Parenteral nutrition (PN) was initiated to provide 100 percent of a patient's nutritional needs, and by utilizing the Home Nutrition Support Team (HNST) approach, the patient was able to be weaned from PN two months after hospital discharge.
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Summary: This case demonstrates the challenges in absorption of micronutrients and macronutrients for patients with Crohn's disease. The combination of B vitamin and chromium deficiency with GI symptoms caused malabsorption and significant loss of weight and bodily function. Repletion of macro and micronutrients using short-term PN at home positively impacted not only the patient's health, but also her quality of life.
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Summary: This case study demonstrates how the Home Nutrition Support Team contributed to the success of this complex, multi-organ transplant patient by providing necessary pharmacy, nutrition and nursing monitoring and clinical feedback to all partners in this patient's care to enhance the post-transplant course and clinical outcomes.
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Summary: This case study demonstrates how the Home Nutrition Support Team contributes to the successful long-term TPN management of a complex patient to enhance her quality of life and help avoid re-hospitalization.
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Summary: Long-term TPN patients may benefit from clinical pathway management as TPN is provided by a variety of home infusion companies with varying levels of expertise and experience. When appropriate, timely intervention with rehabilitation may avoid or forestall the need for transplantation.
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Summary: This case study provides a step-by-step outline of the coordinated efforts made by a national home infusion company's Home Nutrition Support Team to successfully permit a PN-dependent consumer to travel abroad on a vacation of a lifetime.
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Summary: Many therapies are involved in the treatment of hyperemesis gravidarum (HG) including diet changes, anti-emetic therapy, hydration and enteral nutrition and parenteral nutrition support. Although severe HG occurs in less than one percent of women during gestation, it can be severely debilitating and a signicant cause of malnutrition, potentially affecting fetal outcome. Early and effective outpatient intervention improves both maternal and fetal outcomes and significantly reduces costly ER visits and hospital admissions.
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