Home sweet HEN--a guide to home enteral nutrition

Initial experience of home enteral nutrition (HEN) was gained from malnourished patients with Crohn's disease. The rationale for HEN was to improve the patients' lifestyle by reducing the need for repeated admissions for nutritional support: this method is extremely useful in correcting nutritional problems. Over the past ten years the use of HEN has expanded to cover other clinical areas including correction of growth retardation secondary to gastrointestinal disease, cystic fibrosis, inborn errors of metabolism, congenital heart disease, and chronic renal failure, in addition to many types of neoplasia and chronic neurological diseases. At the present time, approximately 150 patients receive HEN within the catchment area of the Greater Glasgow Health Board (population 940,000). Despite the increasing availability of HEN many clinicians and dietitians are still reluctant to consider HEN as a 'routine adjunct' to clinical management, claiming that it is too dangerous or complicated. The aims of this article are to explain our method of running a HEN service, offer advice on practical problems and discuss further developments and potential difficulties.