However, to ensure safety, two to four days of instruction may be required before discharge. The patient or family members must master the nursing functions associated with the array of feeding procedures, including preparation of solutions, addition of medications, attachment of feeding catheters and tubes, control of infusion pumps, care of the intravenous catheter, and use of sterile technique. The individual must be able to monitor the effects of feedings and be able to recognize the signs and symptoms of metabolic or infectious complications. During the last several days of hospitalization, the patient, family members, or both should perform these tasks, with nurses available should problems arise. During the first week at home, a visiting nurse often is scheduled to assist in this self-care process.
Most patients tolerate a regimen of cyclic feedings.
The nutrient formula is infused over 12 to 16 hours, usually during the course of the night so that the patient can be detached from the infusion devices during the day. A visiting nurse and social worker should see the patient at home between outpatient appointments. Frequent telephone conversations are educational for the patient and serve to reinforce solutions to problems that might arise. Blood should be collected during outpatient visits for chemical and electrolyte determinations, especially when fluid and electrolyte balance is a major concern. Blood data form the basis for periodic formula adjustments, which are communicated by the physician to the manufacturing pharmacy or to the patient.