한 병원의 재가 정맥영양요법 (HPN) 평가

Abstract

Home parenteral nutrition (HPN) is the administration of necessary nutrients into the intestine, stomach, or by intravenous infusion to improve or to maintain a patient’s nutritional status in the home care environment. In foreign countries, HPN is used on a regular basis, however in Korea, HPN is in the beginning stages of being adopted. There is no specific management. In 1995, HPN was first used at St. Mary’s hospital in Seoul for nutritional support of patients with chronic intestinal failure (CIF). Since 1998, the nutrition support team (NST) has been leading this system in connection with home care team. The purpose of this study was to improve the management of HPN and to make up for the weak points in pharmacist activities in NST. On a retrospective basis, clinical information was collected from the case records of patients receiving HPN treatment at Seoul St. Mary’s hospital until October 2010. Furthermore, we made a comparative study of HPN management guidelines between Seoul St. Mary’s hospital and the American Society of Parenteral and Enteral Nutrition (ASPEN). In addition, we conducted a survey of patients receiving HPN on satisfaction in management and education. By October 2010, the total number of patients being treated with HPN was 10, 4 for ‘small bowel obstruction’(SBO) and 3 for ‘small bowel syndrome’and administration period of HPN varied from the minimum of 15 months to the maximum of 13 years. Infection of the central venous catheter (mean 1.4 cases/year/person) and dehydration (mean 1.7 cases/year/person) were reported as the major side effects. As the result of the survey, the patients expressed above average satisfaction with administration management and education on HPN, while there were some difficulties with adverse events (n=3) and storage problems (n=2). More active involvement by the pharmacist should be encouraged for better care of these patients through monitoring of their HPN supply, HPN-related side effects, and ongoing patient education. Furthermore, multilateral supports should be provided to promote successful HPN use by establishing definitive standard criteria in medical insurance and, continuing patient education in Korea, as occurs in other countries.