Early History of Home Parenteral Nutrition: From Hospital to Home

Abstract

Technologic advances in the past century have led to the ability to safely deliver parenteral nutrition (PN) to hospitalized patients. Key breakthroughs included the development of saline and glucose infusions, infusion pumps, macronutrients (lipids, dextrose, and amino acids), and central venous catheters. In the 1960s, centrally delivered PN was performed in short-term hospitalized patients by Lincoln James Lawson (North Staffordshire Royal Infirmatory, United Kingdom) and long-term patients by Stanley Dudrick (University of Pennsylvania, United States). These early studies showed that a system was needed that would allow patients with intestinal failure to be discharged from the hospital and receive home PN (HPN). In the late 1960s and early 1970s, Belding Scribner, Maurice Shils, Khursheed Jeejeebhoy, Marvin Ament, Dudrick, and their teams discharged patients from the hospital who then self-administered HPN. Shortly after these early cases of HPN, multidisciplinary centers were established first in North America, and later in Europe, to manage these complex cases. The current article describes the patients treated by these early HPN pioneers, in addition to subsequent case series reported by them and others.

Navigating the Challenges of Home Parenteral Nutrition

“…From the early days of PN, patients and their caregivers have been faced with many challenges. For the first patients, the biggest challenge may well have just been going home from the hospital . Now, there are thousands of HPN patients across the country and around the world living longer and more independently than ever before, but there are many systemic and practical challenges to providing their therapy.…”

“…During its initial phases in evolution, PN was solely able to be administered in the hospital setting. This eventually presented providers with difficult ethical dilemmas that concerned discontinuing a lifesaving therapy, which at the time could not be provided indefinitely . Isolated instances of patients treated outside the hospital with home PN (HPN) began to emerge in the late 1960s and early 1970s .…”

“…In this era, much of that care was significantly different from today's practices. In fact, most patients in this early era compounded their own HPN infusions from base stock supplies they kept at home . Since these early discharges, challenges in home nutrition support have been significant.…”

Repair of Central Venous Catheters in Home Parenteral Nutrition Patients

“…9 Tunneled cuffed catheters were developed in the 1970s as an alternative to the use of an arteriovenous fistula for the administration of PN. 2,10,11 The cuff on the tunneled catheter serves a dual purpose: inhibition of bacterial migration as well as securement of the catheter and prevention of accidental dislodgement. 8 Tunneled cuffed CVCs have been utilized extensively since their development in the HPN field.…”

“…In patients with chronic IF (CIF), parenteral nutrition (PN) remains a mainstay to meet their nutrition and hydration needs . After the successful development and treatment with PN in hospitalized patients in the 1960s, PN was eventually transitioned to the home setting in the late 1960s and early 1970s, and the field of home PN (HPN) was born . Although many changes have occurred in the field of HPN over the years, 1 constant has been the need for long‐term vascular access with a central venous catheter (CVC).…”