American Society for Parenteral and Enteral Nutrition Guidelines for the Selection and Care of Central Venous Access Devices for Adult Home Parenteral Nutrition Administration.

This document represents the American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines to describe best practices in the selection and care of central venous access devices (CVADs) for the infusion of home parenteral nutrition (HPN) admixtures in adult patients. The guidelines targeted adults >18 years of age in which the intervention or exposure had to include HPN that was administered via a CVAD. Case studies, non-English studies, or studies of CVAD no longer available in the United States were excluded.

Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care.

Background: Home parenteral nutrition (HPN) is a high-cost, complex nutrition support therapy that requires the use of central venous catheters. Central line-associated bloodstream infections (CLABSIs) are among the most serious risks of this therapy. Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care (Sustain registry) provides the most current and comprehensive data for studying CLABSI among a national cohort of HPN patients in the United States.

National clinical guidelines and home parenteral nutrition.

Research-based guidelines provide the best evidence and are the cornerstones of achieving quality outcomes for home parenteral nutrition (HPN) patients and their families. However, evidence about the implementation of HPN guideline recommendations is rarely reported. The purpose of this clinical practice project was to compare HPN clinical guidelines with baseline data reported by HPN patients from 1990-2010 and to explore possible facilitators or barriers to the implementation of guidelines in clinical practice.

Complex home care: Part I--Utilization and costs to families for health care services each year.

As many as 120 persons per million people in the United States are dependent on the lifelong, complex, technology-based care of home parenteral nutrition (HPN) infusions. However, data for costs paid by families for HPN-related health care services and for non-reimbursed expenditures are rarely tabulated and most often underestimated. The goals of this study were to describe health care services used by families to manage HPN, report the frequency of each service used annually, and estimate the average annual non-reimbursed costs to families for these health services.

Complex home care: part III--economic impact on family caregiver quality of life and patients' clinical outcomes.

Family caregivers perform a significant role in the care of patients with chronic illnesses and prescribed life-long complex home care treatments. Both quantitative and qualitative data from this study suggest the mental health burdens and financial costs of home parenteral nutrition (HPN) caregiving are extensive. In this study, the variability in HPN out-of-pocket expenses and the uncertainty of incurring such extensive costs created additional financial worries within already stressed families.

Complex home care: Part 2- family annual income, insurance premium, and out-of-pocket expenses.

Annual costs paid by families for intravenous infusion of home parenteral nutrition (HPN) health insurance premiums, deductibles, co-payments for health services, and the wide range of out-of-pocket home health care expenses are significant. The costs of managing complex chronic care at home cannot be completely understood until all out-of-pocket costs have been defined, described, and tabulated. Non-reimbursed and out-of-pocket costs paid by families over years for complex chronic care negatively impact the financial stability of families.

Technology dependence in home care: impact on patients and their family caregivers.

Background: The purpose of this review is to explore how home technology care affects patients, family caregivers, and quality of life (QOL).

Methods: A literature search was conducted to identify studies of home parenteral nutrition (HPN) and other technology prescribed home care.

Results: Technology dependence influences health-related QOL.

Uncertainty about the clinical detection of sepsis.

Clinicians use clinical symptom, blood culture, and central venous catheter (CVC) culture data to detect CVC-related sepsis. The lack of clear and consistent definitions for what constitutes accurate clinical symptom assessments, coupled with the different combinations for blood and CVC culture results, contribute to clinicians' uncertainty about the presence of CVC-related sepsis. When clinical symptoms do not correlate with laboratory culture results, patients are exposed to risks associated with CVC manipulation and inappropriate antibiotic therapy.