Artificial Nutrition Support Home Parenteral Nutrition and Home Enteral Tube Feeding

Patients suffering from chronic conditions often prefer to be treated in the familiar surroundings of their home rather than in hospital. When the treatment involves sophisticated techniques, it is essential that either the patient or the caregiver is adequately trained to distinguish between problems that can be easily remedied at home and those that need expert advice and treatment in hospital. With the increasing pressure for hospital beds and the increasing cost of hospital care, many forms of treatment that were previously restricted to the hospital environment have extended to the community, including renal dialysis, cytotoxic drug therapy, HETF, and HPN. HETF has grown rapidly so that its prevalence in several developed countries is now several times greater than in hospital. In contrast, PN is still practiced less commonly outside hospital than in hospital and is likely to remain so in the foreseeable future. Both forms of treatment have led to the development of professional teams specialising in nutritional support in both the hospital and the community. These teams deal with problems ranging from simple day-to-day management issues to difficult ethical problems, such as concerning withholding or withdrawing nutritional support.

Origins and Development

The first report of HPN appeared in 1970 in North America, and in Europe the first reports appeared in the late 1970s. The number of people receiving HPN has increased considerably since then but remains substantially lower than for HETF (Figure 2).

HETF is a much older technique than HPN, with the first reports appearing centuries ago. Accurate information on the numbers of people receiving HETF is difficult to obtain because HETF tends to be initiated from many centres and centralized reporting and record keeping in most countries are not fully established. There has been rapid growth in HETF attributable to developments in tube technology (flexible fine bore tubes) and endoscopic procedures for placement of gastrostomy tubes (facilitating easier initiation and management of long-term feeding), as well as the development of home care services provided by commercial enteral

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