Home Nutrition Guide
Complete Care Manual for Home Enteral & Parenteral Nutrition
By Pakistan Society for Parenteral and Enteral Nutrition (PSPEN)
What is Home Nutrition Support?
Home Nutrition Support provides life-sustaining nutrition to patients who cannot eat normally after hospital discharge. This guide helps caregivers safely manage Enteral Nutrition (Tube Feeding) and Parenteral Nutrition (TPN) at home.
🏠 Home Enteral Nutrition (HEN)
Liquid nutrition delivered directly to the stomach or intestine via feeding tubes (NG tube, PEG, or Ryle's tube). For patients with swallowing difficulties, stroke, or reduced consciousness.
💉 Home Parenteral Nutrition (HPN)
Complete nutrition delivered directly into the bloodstream via IV catheter. For patients with non-functioning gastrointestinal tract (short bowel syndrome, obstruction, severe malabsorption).
Step-by-Step: Tube Feeding at Home
Pre-Feeding Checklist
- Hand Hygiene: Wash hands thoroughly with soap for 20 seconds
- Patient Position: Ensure patient is sitting at 30-45 degrees (semi-upright)
- Formula Check: Verify expiry date, consistency, and smell. Shake well.
- Tube Position: Confirm tube marking is at correct length. Check for displacement.
- Aspiration Check: Verify gastric residual volume if prescribed by doctor
Feeding Methods
Syringe Method (Bolus)
Connect syringe to tube, pour formula, allow gravity flow. Give over 15-20 minutes. Suitable for intermittent feeding (3-6 times daily).
Pump Method (Continuous)
Set rate as prescribed (ml/hour). Connect feeding bag to pump and tube. Monitor for alarms. Best for 24-hour continuous feeding.
TPN (IV Nutrition) Home Care
Daily Care Routine
- Storage: Keep TPN bags refrigerated at 2-8°C. Remove 1 hour before infusion.
- Inspection: Check for cloudiness, particles, or leakage. Do not use if abnormal.
- Line Care: Clean catheter hub with alcohol before connecting. Never disconnect unnecessarily.
- Air Elimination: Prime line carefully to remove all air bubbles
- Dressing: Keep dressing dry and intact. Change every 7 days or if soiled.
⚠️ Emergency Warning Signs
Contact your doctor immediately or go to emergency if you observe:
Tube Feeding Emergencies
- Tube dislodgement or migration
- Fever > 38°C (100.4°F)
- Severe abdominal pain/distension
- Persistent vomiting or diarrhea
- Tube blockage (unable to flush)
- Respiratory distress during feeding
TPN/Catheter Emergencies
- Redness, warmth, or pus at catheter site
- Chills, rigors, or sudden fever
- Swelling of arm/neck (possible clot)
- Shortness of breath or chest pain
- TPN bag appears cloudy
- Accidental line disconnection
Resources
Check these guides for easy reference at home:
Frequently Asked Questions
If the doctor has approved oral intake, small sips for mouth care are allowed. However, never force fluids if swallowing is impaired. Consult your speech therapist.
Opened ready-to-use formula can be refrigerated for 24 hours. If left at room temperature, discard after 4 hours. Always check manufacturer labels.
Try flushing with warm water. If unsuccessful, use prescribed pancreatic enzyme solution or Coca-Cola flush (if approved by your healthcare provider). Never use force. If still blocked, call for medical assistance.
Yes, with portable infusion pumps. Keep TPN cool in an insulated bag during transport. Carry emergency supplies: extra caps, alcohol swabs, emergency contact numbers, and a letter from your doctor.