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. Samples of our published clinical research can be found below, by topic and year.

Provides clinical resources categorized by Disease, Access, Practice, Symptom and Complications Management
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Summary: Consequences of noncompliance with prescribed home infusion therapy can include ineffective dosing, increased hospital readmissions, and increased costs. Two case studies are presented to illustrate how written agreements, signed by the patient, can help improve compliance for noncompliant home infusion patients.
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Summary: This case study demonstrates that safe, complication-free travel to countries with unknown infrastructure for supporting a traveling infusion patient can be facilitated for patients receiving multiple IV therapies. It describes how a home infusion company enabled a complex, long-term TPN patient to go on a 14-day trip from the U.S. to India while on six IV medications, including three daily liters of TPN and four daily liters of IV fluid.
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Summary: This retrospective patient population evaluation was completed to determine the actual energy intake of cancer patients whose nutrition needs were being supported by tube feeding therapy, as compared to the estimated needs to maintain desirable weight goals. Patient weights and therapy compliance monitoring were measured at regular intervals, and Registered Dietitian (RD)-recommended interventions to improve caloric intake were tracked. Therapy non-compliance due to cancer treatment schedule, patient indifference and gastrointestinal symptoms was noted in a significant portion of the population, and regular RD monitoring of this population was recommended to promote positive nutrition outcomes.
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Summary: This poster provides four case examples of how a home enteral therapy regimen can be altered to adequately meet the patient's unique nutritional needs while reducing their out-of-pocket expenses. The poster shows that it is beneficial to include a home care clinician with insurance acumen in the patient discharge process to assist in maximizing coverage while reducing patient cost burden. By offering low-cost, clinically appropriate therapy alternatives, patient compliance may be enhanced and ultimately patients may experience improved clinical outcomes.
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Summary: Although parenteral nutrition-associated liver disease (PNALD) is a much-discussed topic in the management of home parenteral nutrition patients, there is scant data on incidence and few guidelines for definitive diagnostic methods or disease treatment. A survey of 12 medical experts was completed on this topic to determine whether practice management consensus could be achieved. Tremendous variability was noted in the experts' knowledge of disease incidence, etiology, diagnosis and treatment, and the authors concluded that an evidence-based review of the literature is needed to help clinicians gain a more uniform understanding of PNALD.
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Summary: An analysis of 861 newly discharged home enteral nutrition (HEN) patients was completed to determine the actual and potential therapy-related complications experienced during the patients' first 72 hours at home. The most common HEN start-of-care complications were outlined, as well as the reasons for home Registered Dietitian (RD) interventions. Over 79% of patients evaluated required additional education or support from the HEN RD within 72 hours of discharge, resulting in the recommendation to include RD monitoring post-discharge for all HEN patients to optimize clinical outcomes.
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Summary: Three home enteral patient case studies were presented to demonstrate the types of common complications home enteral Registered Dietitians (RDs) are often faced with in their daily management of this population. Experienced home nutrition support RDs are integral in providing patient education, assessment and monitoring to promote positive clinical and quality-of-life patient outcomes.
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Summary: This case study highlights how the use of a custom-made parenteral nutrition formula allowed a two-month-old patient with 3-methylcrotonyl-CoA carboxylase (3MCC) deficiency to receive a reduced amount of leucine yet still receive sufficient protein for growth and development. The custom formula restricted the specific amino acids that were not able to be metabolized properly, while providing adequate protein from other amino acids to promote growth and development.
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Summary: In the home care setting, there is limited data regarding the availability and efficacy of clinical oversight programs for tube feeding patients. This survey quantifies the number of tube feeding patients who received order changes and the reason for the change orders as a way of demonstrating that appropriate clinical oversight, given by a home care Registered Dietitian, can promote better outcomes. Hospital readmissions specifically related to tube feeding complications were also tracked and quantified.
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Summary: Intestinal failure-associated liver disease (IFALD) can occur in both adult and pediatric parenteral nutrition patients and may lead to a combined liver-intestine transplant. While an exact treatment has not yet been determined, there has been reported success, primarily in the pediatric population, with the use of a fish oil-based lipid emulsion (FOLE) that may help to ameliorate IFALD. This case study presents the second reported North American adult patient dependent on parenteral nutrition to receive FOLE.
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Summary: More than 15,000 cases of head and neck cancers are diagnosed each year, and patients often require enteral nutrition (EN) via a gastrostomy tube. The percutaneous endoscopic gastrostomy (PEG) tube has become the preferred technique for EN access because placement is a minimally invasive procedure. This case study looks at commonly used PEG placement techniques as well as tumor seeding, a unique complication with some types of PEG placement.
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Summary: Long-term total parenteral nutrition (TPN) patients rely on nutrition therapy to maintain their nutritional well-being and pursue satisfying lives. However, their care is generally not standardized, and there are wide variations in patient management. This study evaluates a sample of ultra long-term patients, as defined by a >18-month length of therapy, to gain greater insight into the influence of patient demographics and care management on clinical outcomes.
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Summary: Drug shortages in the U.S. have been at a record high this year as recorded by the FDA. In particular, electrolytes and trace minerals for parenteral nutrition (PN) solutions have been limited or not available, a situation that has triggered multiple changes in PN prescriptions. Based on a survey sent to 46 pharmacists and dietitians who manage PN patients within a national home infusion company, this study evaluates the impact of the PN drug shortages on patient care, labor, and physician orders for clinical monitoring.
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Summary: Home enteral nutrition (HEN) can improve patient quality of life, but also brings a variety of questions and issues that may arise when provided outside of the clinical setting. The use of currently available technology, such as email and texting, to send visual images has become a valuable resource in providing HEN patients with effective and efficient clinical care, including device troubleshooting. This study looks at how this technology aides in successfully managing the HEN patient by providing accurate and expedient solutions to everyday feeding and device issues.
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Summary: Although patients may have resources available to them through their enteral home healthcare provider, those receiving tube feedings in the home setting seem to contact physicians first when they need help. To learn why most patients aren't contacting their home healthcare provider first, a survey was sent to patients of a national home healthcare company. The survey asked questions about the patients' home tube feeding regimens with either a gastrostomy or a jejunostomy tube. This study reports on the findings from that survey and suggests that earlier contact with their home care provider will likely help identify issues and complications earlier, and allow for prompt intervention and ultimately increased compliance to regimen.
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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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