title: AuSPEN clinical practice guideline for home parenteral nutrition patients in Australia and New Zealand.
abstract: 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.
authors: Nutrition Services, Auckland City Hospital, Auckland, New Zealand. LynnG@adhb.govt.nz
authors: Lyn
authors: L
authors: Gillanders
authors: Katherina
authors: K
authors: Angstmann
authors: Patrick
authors: P
authors: Ball
authors: Christine
authors: C
authors: Chapman-Kiddell
authors: Gil
authors: G
authors: Hardy
authors: Janet
authors: J
authors: Hope
authors: Ross
authors: R
authors: Smith
authors: Boyd
authors: B
authors: Strauss
authors: David
authors: D
authors: Russell
mesh_terms: 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