A structured multidisciplinary home parenteral nutrition program in a public healthcare system: Implementation model, nursing‐led training protocol, and 11‐year safety outcomes
Tatiana da Cunha Rana, Mariana Hollanda Martins da Rocha, Luiz Augusto Carneiro d'Albuquerque, André Dong Won Lee, Wellington Andraus, Luciana Bertocco de Paiva HaddadAbstract
Background
Home parenteral nutrition (HPN) is the standard of care for adults with chronic intestinal failure (CIF), but evidence from publicly funded healthcare systems in middle‐income countries is limited. This study describes an 11‐year experience of a structured, nursing‐led HPN program within Brazil's Unified Health System (SUS), reporting the program model and catheter‐related safety outcomes.
Methods
This was a retrospective observational cohort study including 20 adults with CIF followed between January 2014 and December 2024. The primary outcome was catheter‐related bloodstream infections (CRBSI) incidence density per 1000 catheter‐days (exact Poisson 95% confidence interval [CI]). Secondary outcomes included mechanical complications, hospital readmissions, and mortality.
Results
Across 81 central venous catheters and 45 046 catheter‐days, 13 CRBSI episodes occurred (incidence density 0.29/1000 catheter‐days; 95% CI: 0.15–0.49). An additional 12 local catheter infections not meeting CRBSI criteria were recorded, yielding an overall catheter‐related infection rate of 0.55/1000 catheter‐days. Median pre‐discharge nursing training was 23 days. Gram‐positive organisms predominated (53.8%). Catheter removal was performed in 76.9% of CRBSI episodes. Mechanical complications affected 34.6% of catheters. Three deaths were recorded; none occurred in the final 5 years of follow‐up.
Conclusion
These findings support the feasibility of safe long‐term HPN delivery in resource‐constrained public healthcare settings and describe a replicable implementation model encompassing structured multidisciplinary care, formalized nursing‐led training, and graduated post‐discharge follow‐up. The subsequent incorporation of HPN into Brazil's national health policy adds real‐world relevance to this experience.