Home Parenteral and Enteral Nutrition

PN is also known as Total Parenteral Nutrition (TPN). This medical therapy provides essential nutrients and fluids through a vein. PN is used when a person's gastrointestinal (GI) tract does not work as it should. This can be for many reasons, such as surgical complications or intestinal failure. 

The BC Home Parenteral Nutrition (HPN) Program helps transition patients to home care and supports them at home. HPN patients receive a personalized nutrient solution. It includes all needed proteins, carbohydrates, fats, electrolytes, vitamins, minerals, and fluids. 

The solution goes directly into the bloodstream. This is done with a central venous catheter (CVC) and an infusion pump. The CVC is inserted through your skin into the main vein leading to your heart. 

HPN is only appropriate for those needing long-term PN (over three months). Patients need to be able to manage the procedure themselves or have caregivers who can. It is not appropriate for those on  short-term PN (less than three months) or needing daily medical care. HPN duration varies from months to a lifetime. Many patients are on it for five to eight years. The longest user in British Columbia exceeded 30 years.

EN is a medical therapy also known as “tube feeding.” People on tube feeding have a functioning gut but cannot eat or drink enough due to a medical condition. 

EN delivers special liquid food, called formula, into the stomach or small bowel. The formula contains protein, carbohydrates, fat, vitamins, minerals, and fluid.

It is delivered with a tube and an infusion pump, gravity or a syringe. Sometimes, people drink their formula instead of using a tube. 

Home Enteral Nutrition (HEN) allows patients to receive EN at home once they are medically stable. Patients must be able to manage tube feeding themselves or with a caregiver’s help. Duration varies from months to lifelong.

The BC HEN program gives formula and supplies for patients who need EN for specific reasons.

To take part in the HPN program, your care provider needs to submit an application. 

See HPN eligibility criteria and application details.

Once we receive your application: 

• We will review your medical and surgical history and nutritional status. We will also consider your medications and ability to do PN at home.
• After reviewing the application, we may arrange a meeting via Zoom or phone. The meeting will be with our physician and dietitian. They will decide if you are medically and nutritionally suitable for HPN.
• We may recommend changes to your medications and diet. We may also suggest ways to care for related medical conditions. These include an ostomy, fistula, wounds or diabetes.
• If you are a good fit, we will arrange a call with you and your caregiver to assess your ability to be trained. This usually takes 45 minutes.
• If we accept you into the program, we will set up a time for you to come to St. Paul’s Hospital for training. 

All patients and caregivers who need HPN must come to St. Paul’s Hospital for assessment and training. 

You have to be “discharge ready” before transferring to St. Paul's Hospital. This means you have to be medically and functionally stable enough to go home. The only thing keeping you in the hospital is the need for PN.

There is usually a wait time of two to four weeks. The length depends on:

• Your medical and nutritional status
• Your medications
• Your ability to be independent at home, with or without the help of a caregiver
• The number of other patients on the waitlist
• The number of available beds at St. Paul’s Hospital

If you need to transfer to St. Paul’s Hospital from another hospital:

• We will select a transfer date. 
• We will arrange for you to travel by ambulance through the BC Patient Transfer Network.
• The transfer might be delayed if there is not a bed at St. Paul’s Hospital or available ambulance. Delays can occur because of urgent (critical care) transfers or bad weather. 
• If the transfer is delayed, we will communicate daily with the “sending” hospital until it happens. 
• Sometimes, the ambulance will let a spouse or family member travel with the patient. This is only if there is space. It is not guaranteed.

If a caregiver is coming for training, they will need to arrange their own transportation. The BC HPEN Program is not funded to cover the cost of travel or accommodation for caregivers. 

The following programs may provide transportation support: 

• Travel Assistance Program 
• Health Connections 

We can also provide a letter for taxes or third-party coverage.

• Taken to your bed and met by a nurse.
• Seen by a physician on the gastroenterology (GI) team. They will write orders for blood tests, diet, medication and more. 
• Started on PN in the evening if you were on PN before coming to St. Paul’s Hospital.
• Given time to rest. The HPN assessment and training usually begin the morning after you arrive. 

You will be at St. Paul’s Hospital for two to three weeks. During this time, we will:

• Provide HPN training.
• Adjust your PN prescription to ensure it is safe for home use.
• Check your blood work. 
• Assess your diet and provide recommendations if needed.
• Review your medications and make changes if needed.

Your stay at St. Paul’s Hospital may be longer if:

• You need a new CVC inserted.
• We need to make changes to your PN prescription.
• You need extra or unplanned medical tests.
• Your training is postponed because you are unwell. 

You will have one to two training sessions every weekday (Monday to Friday). Your schedule will vary each day. Your HPN nurse will communicate with you daily.   

During training sessions, you will learn about:

• Different types of CVCs
• Caring for your CVC and potential complications
• Practicing good hand hygiene and using aseptic (sterile) technique
• Adding vitamins and medications to your PN solution
• Connecting your CVC to your PN bag
• Using the infusion pump
• Unhooking your CVC from your PN bag
• Using the gravity method of infusion for extra fluids
• Ordering your home PN solutions and supplies
• Going for regular blood tests
• Visiting the outpatient clinic
• Risks with HPN 

If you or your caregiver cannot complete the training or safely administer HPN, we will transfer you back to the hospital that referred you to us. The hospital will make a new plan.

When you finish your training, we will determine a discharge date. 

You are responsible for getting home. We suggest having someone assist you with travel. We can also make a referral to a social worker to assist you, if you need. 

We will make sure your first order of PN solutions and supplies are delivered to your home. 

• The first delivery usually happens the day before or the day of your discharge.
• You may need to have someone at your home to accept the delivery on your behalf. 
• The delivery also includes a refrigerator for your PN solutions.

At home, you will spend about 1.5 to two hours each day managing your PN. This includes:

• Preparing the solution
• Connecting to the solution
• Maintaining the infusion pump
• Disconnecting from the solution. 
• Assessing and caring for your CVC

The amount of time spent on these tasks will decrease as you gain experience.

You will be connected to the infusion pump for about 12 to 14 hours each day, Often this is while you sleep. 

You will also need ongoing medical care. This includes:

• Regular blood tests to see if the solutions are giving you the nutrition and fluid you need. We will let you know how often you need to have blood tests done.
• Regular phone calls with our team. 
• In person, virtual or phone follow up appointments with our team. Your first appointment after your discharge must be  in person. 

Ongoing appointments with your family physician and specialists. Your family physician will manage your underlying medical conditions other than HPN care.

You are responsible for ordering your solutions and supplies. Your HPN solutions and supplies are 100% paid for by the BC HPN Program.

You can order supplies through the program supplier  Calea. 

• To place an order, call 604-294-1500 ext. 5.
• Calea takes five to seven business days to process and deliver an order anywhere in B.C.
• They will ship your solutions and supplies to you, usually every two weeks. 

Our program does not pay for or provide non-HPN medications or supplies. For example, we do not pay for supplies you might need for your ostomy, fistula or non-home PN medications.

• Space. You will need enough room to keep your supplies. This includes an extra fridge to store solutions.
• Physical strength. HPN solutions and equipment are heavy. You will need to be able to lift and move the solutions or have someone help you. 
• Risks. HPN has risks. You must learn about these risks, how to prevent them and how to spot them for prompt treatment. Some complications can be life-threatening if not addressed in time. Your HPN nurse will discuss these risks in detail during HPN training. 

If you have any problems related to your HPN, call the BC HPN Program’s nurse or dietitian. If it is an emergency, go directly to the nearest emergency room.

The Oley Foundation also provides a helpful HPN Complication Chart. It has information on:

• Infection
• Hyperglycemia
• Hypoglycemia
• Dehydration
• Air embolism
• Blood in catheter
• Cracking of hub
• Catheter tear
• Catheter clot
• Inflammation of vein in PICC users
• Pump or power failure

You can also consult the Ambix Activ® Instruction Manual for pump related concerns. 

You should prepare for disasters, since you need:

• Electricity to keep your PN solutions cold and operate your infusion pump.
• Water to wash your hands. 
• Access to hospitals and emergency rooms. 

To prepare, download the emergency preparedness booklet: 

My Emergency Preparedness Plan: Information for and about Adult Patients of the BC Home Parenteral Nutrition (HPN) Program

HPN is a good option if you will be on PN for more than three months. You also need to be able to perform the procedure yourself or have a caregiver who can. It is not an option if you will be on PN for a short time (less than three months) or need daily medical care. The length of time patients stay on the program varies from a few months to life.

Hydration therapy is when fluids are infused into your bloodstream. It is used when you cannot drink enough to keep you hydrated. It can be given alongside PN.

There are a small number of private and semi-private rooms at St. Paul's Hospital. They are often used by very sick patients who can easily spread or catch an infection.

If you would like a bed in a private or semi-private room, you can let the unit clerk on your ward know. There is an extra cost if it is not medically required. Some extended health care plans may cover this cost.

Yes, we provide day passes for weekend daytime outings. You are eligible if you are medically well and on overnight PN. You cannot leave if you are also on daytime PN or on continuous IV fluids or IV medications.

Day passes are not available on weekdays since this is when you will do your training. 

You can discuss day passes with our team once we have admitted you to St. Paul's Hospital.

Yes, you can travel while on HPN. Travelling requires careful planning, and there are restrictions to consider. Be sure to inform our program before making any plans more than six weeks in advance. You are also responsible for all costs beyond what the program normally covers.

Swimming is not recommended while you have a CVC. This is because it increases the chance of infection. Hot tubs and baths are also not recommended. Please check with us to discuss this further.

Most people can return to their normal exercise routine. However, you should avoid contact sports. Check with your physician before starting or resuming exercise. You will also need to gradually increase your exercise levels.

• Notify us. Make sure the hospital contacts us when they admit you. This helps ensure you receive the best care. 
• Notify Calea. Call Calea customer service to inform them about your hospital stay. They will pause deliveries until you are ready to go home.
• Leave your PN bags and supplies at home. Do not bring them to the hospital. The hospital will provide you with PN. In rare cases, they may ask you to bring your solution from home.
• Plan for discharge. Give us enough notice before you leave the hospital. The hospital might change your PN solution. These changes need to be communicated to our program’s dietitian. We also need to deliver your solutions to your home, which can take up to seven business days.

To take part in the HEN program, your care provider needs to submit an application. Please note the BC HEN program has very specific program criteria.  The application review process usually takes about two to three weeks.

See HEN criteria and application details.

If we approve your application, we will send  an approval letter. This outlines the formula and supplies approved for you. It also says how long your HEN formula and supply approval will last. 

Please note: The BC HEN programs only process funding for HEN formula and supplies. We are not involved in patient clinical or medical care. Please contact your family physician, specialists, or dietitians. They can help with any clinical or medical questions or requests.

We will organize the first delivery of your formula and supplies. You will be responsible for all other formula and supply orders.

You can do this by contacting the BC Government Product Distribution Centre. 

• To place an order, call 604-927-2910 or 1-877-927-2234 or email PDC.Callcentre@gov.bc.ca.
• The Product Distribution Centre takes two to three business days to process and deliver orders.  
• They will ship your formula to you.

Your HEN formula and supplies are 100% paid for by the BC HPEN program. Our program does not pay for or provide non-HEN supplies or HEN pumps. 

Your care provider must apply to renew your participation in the program. They also need to apply to change your formula. See referral details.

Formula usually includes protein, carbohydrates, fat, vitamins, minerals and fluid.

Common types are:

• Polymeric. This formula has protein that has not been broken down. It is for people with normal gut function who cannot eat or drink enough because of an illness or swallowing problem. Our program supports pediatric patients with these formulas exclusively for Exclusive Enteral Nutrition (EEN) purposes in the treatment of Crohn's disease. Polymeric formulas are not supported by our programs for adult patients. 
• Semi-elemental. This formula has partially broken down protein. It is for people with moderate gut function who may struggle to digest or absorb food. They might also be sensitive to whole proteins.
• Elemental. This formula has fully broken down protein. It is for people with limited gut function or severe food allergies. It is also for people who have difficulty tolerating semi-elemental formulas. 

• Time - The time spent on HEN depends on factors like your type of feeding tube, formula and how long infusion takes. 
• Space - You will need enough room to store your formula and supplies at room temperature to keep them dry. 
• Physical strength - HEN formulas often come in heavy cases. You will need to be able to lift and move them or have someone help you. 
• Risks - HEN carries risks. You must learn about these risks, how to prevent them and how to spot them early for timely treatment. Some complications can be life-threatening if not addressed in time.

For general troubleshooting, view the Oley Foundation’s Home EN Troubleshooting Guide. 

If you have problems, call your physician, nurse or dietitian. Please do not contact our program, as we do not have the clinical staff to help. If it is an emergency, go to the nearest emergency room.

You should prepare for disasters, since you need:

• Electricity to operate your feeding pump.
• Water to wash your hands, flush your feeding tube and rinse feeding bags and syringes. 
• Access to hospitals and emergency rooms.

To prepare, download the emergency preparedness booklet:

My Emergency Preparedness Plan: Information for and about Adult Patients of the BC Home Parenteral Nutrition (HPN) Program

HEN is a good option for patients who need EN for a long time. They should be able to perform tube feeding or have a caregiver who can help. HEN can last from several months to life.

You can order your formula and supplies from our supply company, Product Distribution Centre. We will arrange your first order. Once home, it is your responsibility to order your formula and supplies every month. To place your order, call 604-927-2910 or 1-877-927-2234 or email PDC.Callcentre@gov.bc.ca.

Yes, you can travel while on HEN. However, you are responsible for all aspects of your trip. Before booking, it is best to discuss your travel plans with your physician.  

You should:

• Get a travel letter about your medical needs.
• Get travel medical insurance.
• Remember to factor in the extra weight of your pump, formula and supplies in your luggage.
• Label your luggage as "Fragile" and "Medical Supply."
• Have contact information for health care professionals at your destination.

It is best to discuss this with your doctor. Generally, if the water is safe, you can go swimming if you have a healed and healthy stoma site. 

Learn more

Most patients can return to their normal exercise routine. However, it is important to check with your physician first. Make sure to gradually increase your exercise activities. While most activities are fine, avoid contact sports if you have a permanent feeding tube.

Let the hospital physician, nurse and dietitian know that you are on HEN. They can make sure you receive proper nutrition during your stay.

If the hospital’s health care team changes your formula, tell our program at least five to seven business days before your discharge. Your physician and dietitian will need to complete a Formula Change Application and send it to us.

If you are part of the program and no longer need formula and supplies, contact us right away. Please also contact the Product Distribution Centre at 604-927-2910 or 1-877-927-2234 or email PDC.Callcentre@gov.bc.ca to return unused formula and supplies.

If you do not qualify for our program, you might be eligible for another one. 

• See the Overview of BC Provincial and Federal Nutrition Benefits Programs.
• Some private extended health benefit programs may cover HEN formula or supplies.
• The Oley Foundation Equipment/Supply Exchange is also an option for formula, pumps and pump supplies. The website lists items donated by other patients. Items are free, and you will need to cover shipping and handling costs.