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Psychosocial Aspects HPN staff needs to assess family's ability to provde PN care at home. This process is similiar to transplant assessment of patient, as the alternative is continued hospitalization on HPN until PN can be discontinued OR issues can be resolved OR sometimes intestinal transplant...

For a PDF version of the FAQ's, click here What if patient has a fever? Refer patient to the emergency department. Do not reassure family over the phone. For red flag symptoms, tell them to dial 911 (altered mental status, chills, seizures). Tell family to anticipate admission for at least 48 hours...

Case #1 7 year-old on PN 1500 ml/day over 24 hours and (3 gm/kg) 310 ml/day over 24 hours •PN and lipid pumps are mixed up •IL runs at 63 ml/hour, instead of 13 ml/hour •What do you need to watch for? Read more about management here

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Central Venous Catheter cuff exposed The central venous catheter dacron cuff is supposed to be underneath the skin, so it can hold the catheter firmly within tunnel. Here we see the catheter malpositioned with the dacron cuff externalized. Purulent discharge from CVC exit site Cellulitis around...

6 month-old male on home parenteral nutrition presents to emergency department with sudden onset altered mental status. On exam, patient is non-responsive, temperature 35 degrees Celsius, HR 180, blood pressure undetectable, skin is modeled. The central line site is clear. Blood cultures have been...

Patient is 13 year-old female unable to tolerate any enteral intake due to chronic small bowel obstruction and a history of heavy menses. For past 6 months, she complains of worsening fatigue and pallor. Hemaglobin is 8 (low), MCV 66 (low and previously normal). On exam, there is no tachycardia...

Patient is an 8 year-old female with HPN dependence due to short bowel syndrome. She has high ostomy due to proximal stoma. Height velocity gradually slows over the last 12 months. Receiving adequate calorie and fluid support. Compliance has been assessed to be satisfactory. On history, parents...

The parent of an 8 year-old female with chronic parenteral nutrition dependence secondary to chronic intestinal pseudo-obstruction calls with leaking at right upper extremity peripherally inserted central catheter(PICC) within 2 hours of nightly infusion. What is the first thing to recommend to...