Current practices for home enteral nutrition

Home enteral nutrition support is a rapidly expanding area providing new challenges for the clinical dietitian. It begins with identification of appropriate candidates based on their physical condition, home environment, and goals of therapy. A thorough nutrition assessment is performed to determine macronutrient and micronutrient needs. Considerations for formula selection include the form and source of nutrients, cost, and goals of therapy. Administration may be by a bolus, intermittent gravity drip, continuous infusion, or cyclic infusion method. Selection of an appropriate access route should consider the length of therapy, medical condition, pathology of the gastrointestinal tract, and the infusion method. Discharge teaching should stress maintenance of the patency and tube position, accurate formula delivery, and proper use of equipment and supplies. Issues involving reimbursement and financial responsibility should be addressed before the home therapy is initiated. Home patients should be monitored and reassessed regularly to update the plan of care and goals of therapy. Vendors should be selected on the basis of their capability to meet the patient's needs. If all phases are implemented, home enteral nutrition is a safe and acceptable means of nutrient delivery.