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Review
British Intestinal Failure Alliance (BIFA) guidance - haematological and biochemical monitoring of adult patients receiving home parenteral nutrition
  1. Gavin William Mercer-Smith1,
  2. Colette Kirk2,
  3. Lisa Gemmell2,
  4. Christopher Mountford3,
  5. Jeremy Nightingale4,
  6. Nick Thompson3
  1. 1Blood Sciences, Newcastle upon Tyne Hospitals Department of Laboratory Medicine, Newcastle upon Tyne, UK
  2. 2Nutrition - Newcastle Hospitals, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  3. 3Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  4. 4Gastroenterology, London North West University Healthcare NHS Trust, Harrow, London, UK
  1. Correspondence to Dr Gavin William Mercer-Smith, Blood sciences, Newcastle upon Tyne Hospitals Department of Laboratory Medicine, Newcastle upon Tyne NE1 4LP, UK; gavin.mercer-smith{at}nhs.net

Abstract

Home parenteral nutrition (HPN) is necessary for patients with prolonged intestinal failure which can be secondary to a variety of pathophysiological mechanisms or surgical resection. HPN is needed to supply micronutrients, macronutrients and water to reduce morbidity and mortality and to maximise the patient’s quality of life.

HPN requires close monitoring by a dedicated multidisciplinary team and is vital to minimise complications; both catheter related and metabolic. A regular comprehensive review is required including history, examination including anthropometry and blood testing. The focus of this review is on the monitoring of haematological and biochemical parameters.

There is a paucity of evidence-based literature on the biochemical monitoring of HPN and existing guidance is sourced mostly on expert opinion and lower grade studies. Sources offering guidance on the frequency of biochemical monitoring for the stable adult HPN patient are the British Association for Parenteral and Enteral Nutrition, the European Society for Parenteral and Enteral Nutrition, the National Institute for Health and Care Excellence and the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN).

The aim of this work is to review and collate this existing guidance into one clear and concise review. It is recommended that biochemical parameters are checked at baseline, thereafter more frequently if concerns arise and less frequently when the patient’s condition is stable, as assessed by the multidisciplinary team with expertise in HPN.

  • parenteral nutrition
  • nutritional status
  • micronutrients
  • trace elements
  • vitamins

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Footnotes

  • Correction notice This article has been corrected since it published Online First. The title has been amended.

  • Contributors GWM-S, CK, LG and NT conducted the literature search, analysed literature and wrote the article. GWM-S, CK, LG, CM, JN and NT drafted, edited and revised the manuscript. Members of the BIFA committee reviewed and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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