If your hospital team think you may need home parenteral nutrition, then you may need to be transferred to Cardiff and the Vale health board for an assessment. An assessment may take on average 3-6 weeks depending on your health, fitness and social circumstances. This will all be discussed with you on arrival. Unfortunately, we have limited specialist HPN/HPS beds so you may have to wait a while until a bed becomes available. We review this daily. 

When you arrive in Cardiff you will be admitted to our Gastroenterology Ward which is ward A7. Here you will be greeted by our friendly nurses who will help you settle in. During your first week you will meet our team who will make arrangements with you to be assessed. This may require further scans, changes in medications, blood tests, fluid monitoring or any other monitoring deemed necessary. 

Tests and Investigations

• Blood tests - You may need to have blood tests taken daily to monitor your response to any treatments or changes to any medications. Whilst an inpatient you will also have Parenteral Nutrition related bloods taken twice a week on a Wednesday and Sunday to check your liver and body salt levels and a full nutrition screen to check your vitamins and minerals. 
• Investigations - As part of your assessment you may be required to have further investigations to rule out possible complications and give us a better understanding of your anatomy. These investigations may be in the form of Scans such as x-rays, CT and MRI or Endoscopic Camera tests to look directly into your gut. 
• Diet and Fluid Monitoring - To get a better understanding of requirements we may ask you to be 'nil by mouth' in the first instance which will enable us to get a baseline record of what bodily fluids (urine and faeces) you are losing. This allows us to see how eating and drinking then effects these bodily fluids. Don't worry, this will only be for a short period and you will receive some Parenteral Support during this time if not already on it. For us to correctly measure and workout your nutritional requirements our nurses will need to complete daily fluid and food monitoring. If you are able, we would encourage you to keep a record of this and either write it down on the charts we can provide you or inform the nurses throughout the day so they can update the charts for you. 
• Medication Review - Certain medications can have a direct impact on your condition. Medications such as painkillers, anti-sickness drugs, Loperamide may be either stopped, reduced or started depending on your condition. Therefore, as part of your initial assessment our nutrition team will review all medications and discuss these with you. 

If it is determined that you require home parenteral nutrition our consultants and specialist nurses will discuss this with you and provide you with all the necessary information, most of which can be found on these webpages.

You will require a central venous line and the type of line you have will be determined after you have been assessed. This may be a tunnel line or a PICC line. Our specialist nurses will also carry out an assessment on you and/or a family member to check your ability to carry out line care and connect/disconnect your HPS. This will enable you to live life independently.

Over the following weeks you will be provided with a training pack and our specialist nurses will undergo training with you or your family member so that you can safely carry out your own procedures. Don't worry our nurses won't allow you to do anything you are not confident to do. 

Once you have completed all your assessments, full nutrition screening and are deemed stable on your HPN/HPS our pharmacists and dietitians will create a prescription for you. Your prescription will then be sent to a suitable homecare provider. When accepted your homecare provider will provide you with dates to complete both an in-hospital and home assessment. If no issues have been identified at this point you should be ready for discharge. 

Advice on Discharge - We aim to discharge patients before 12pm the day of discharge to ensure they are home ready for their homecare team. Patients are asked to arrange their own transport. In special circumstances hospital transport may be agreed. If you have any transport issues, please let the ward staff know as soon as possible (no later than 48hrs prior) so not to delay your discharge.

After discharge home you will be seen in the Specialist Nutrition clinic (suite 5) after 4-6 weeks to check on your progress. If well, you will be further seen in clinic at least every 6 months but more often if needed.  It is important you attend your clinic appointments. Due to the high risks HPS poses, missing clinic appointments and vital bloods could result in your HPS prescription being held until deemed safe to issue a new prescription. 

In the specialist clinic you will be reviewed by a few team members and sometimes students. Our nurses will ensure your bloods are done, check on your line and weigh you. If you are experiencing problems and want to bring the appointment forward or arrange a video consultation you can contact the team to arrange. When attending the clinic, you should bring a list of current medication, and a note of any questions you want to ask.

There is no reason why you cannot undertake 'normal' activities of daily living whilst having HPN/HPS. If there is an activity you'd like to be involved in and are unsure of please ask the team.