Several Nutrishare pharmacists, our dietician, and I attended the American Society for Parenteral and Enteral Nutrition (ASPEN) Clinical Nutrition Week in Chicago, IL last month. This conference focuses on topics related to nutritional support in the hospital and outpatient settings.  Nutrition experts present a wealth of knowledge for clinicians to take back to their practice.

I presented a nutrition practice poster entitled “Self-Administered Alteplase in a Home Total Parenteral Nutrition Population.”  This was awarded Abstract of Distinction and 2nd place in the Home Care section.  I will highlight the “take home” information from this poster.

I contacted a group of 36 Nutrishare home TPN consumers who had physician’s orders for alteplase administration in the home setting.  Alteplase is a fibrinolytic agent that has been shown to be safe and effective in restoring catheter patency.

Thirteen consumers in Group 1 used alteplase on a routine monthly basis and 23 consumers in Group 2 used alteplase as needed to treat catheter sluggishness or clotting.  Group 1 had one clotting episode and 15 sluggish events, and Group 2 experienced 4 clotting and 31 sluggish episodes.  All incidences were successfully treated without catheter loss, and no adverse effects were noted.  Without home self-administration, a trip to the MD office or emergency room would be necessary, thus delaying treatment.  The average distance to treatment was 20 miles with an estimated wait time of 2-6 hours.

Although the difference between the two groups was not statistically significant, this study demonstrates that TPN consumers who are knowledgeable in troubleshooting catheter dysfunction can safely manage this therapy in the home setting.  This avoids timely and costly hospital admissions, and reduces exposure to hospital acquired infections and health care providers who are not familiar with access devices.  Based on this preliminary data, monthly vs. as needed treatment seem to be equally effective.

Home TPN consumers who experience occasional catheter sluggishness, pump occlusion alarms, and clotting should discuss this therapy with their physician. With instruction and oversight from a nurse or pharmacist, self-administered alteplase is a safe and effective home therapy.