AuSPEN clinical practice guideline for home parenteral nutrition patients in Australia and New Zealand.
OBJECTIVE
Evidence based guidelines for home parenteral nutrition (HPN) were commissioned by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) and developed by a multidisciplinary group. The guidelines make recommendations in four domains: patient selection, patient training, formulation and monitoring regimens, and preventing and managing complications.


METHODS
The Appraisal of Guidelines Research and Evaluation guideline process was used to focus questions and identify evidence by systematic literature reviews of meta-analyses and randomized control trials in the Cochrane Library, Medline, Embase, and Cinahl to mid-2007. Where no randomized control trial evidence was found, the search was broadened to observational studies and expert opinion from related national and international guidelines as assessed by a validated appraisal process.


RESULTS
Selection of patients must assess individual risk/benefit and medical ethics. Patient training should be undertaken within a structured framework. Access devices should be selected for lowest risk of complications, including occlusion, sepsis, and breakage and be managed by early diagnosis and treatment. HPN should be formulated according to individual patient requirements by professionals with relevant skills and training. Pumps and ancillary products should conform to quality standards. Other intravenous medications may be prescribed provided these are reviewed for compatibility and effects on metabolic status.


CONCLUSIONS
Overall there is a lack of randomized control trials to provide high-quality evidence-based guidance but graded recommendations can be made. Multidisciplinary teams in centers with HPN management expertise are required for optimal care. This guideline should improve outcomes and quality of life for HPN patients in Australia and New Zealand.
Gillanders
Lyn
L
Nutrition Services, Auckland City Hospital, Auckland, New Zealand. LynnG@adhb.govt.nz
Angstmann
Katherina
K
Ball
Patrick
P
Chapman-Kiddell
Christine
C
Hardy
Gil
G
Hope
Janet
J
Smith
Ross
R
Strauss
Boyd
B
Russell
David
D
D001315:Australia; D019317:Evidence-Based Medicine; D006801:Humans; D009520:New Zealand; D016331:Parenteral Nutrition, Home / Q000009:adverse effects / Q000592:standards*; D010353:Patient Education as Topic; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention; D018570:Risk Assessment; D012955:Societies, Medical