A structured multidisciplinary home parenteral nutrition program in a public healthcare system: Implementation model, nursing-led training protocol, and 11-year safety outcomes.

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.