ANSWERS

Intradialytic Parenteral Nutrition (IDPN) is a supplemental form of parenteral nutrition prescribed to provide malnourished hemodialysis patients with the protein, calories and other nutrients that their body needs for strength and energy. NutriRite™ is the Patient Care America brand of IDPN therapy.

The dialysis clinic is provided with an infusion pump and IV pole for each patient in order to safely infuse the NutriRite™ IDPN therapy. A weekly supply of NutriRite™ IDPN solutions, related medications, and infusion sets are sent for each patient unless another delivery schedule is specified. Upon request, the dialysis clinic receives a refrigerator with a thermometer to be designated for the storage of NutriRite™ IDPN bags and ancillary medications.

Fax or call a Patient Care Coordinator with the initial referral information. The Patient Care Coordinator will begin the referral process and patient evaluation.

After the referral is called into Patient Care America and the patient has received authorization from their insurance provider for NutriRite™ IDPN, therapy can be initiated. The process from referral to approval takes approximately one week depending on how quickly the insurance company responds and if additional information is required. Prior to the administration of the NutriRite™IDPN, an in-service will be scheduled to fully train your staff.

Patient Care America is responsible for the service and repair of the pumps and will replace a pump every 12 months as part of our preventive maintenance schedule.

A Patient Care America Team member will be available to provide an in-service to the dialysis clinic staff. In addition, a team of Clinical Pharmacists, Clinical Nurse Specialists and Clinical Renal Dietitians are available by phone for consultation.

Approximately 5-10% of chronic hemodialysis patients qualify for NutriRite™ IDPN therapy due to malnutrition based upon a nutritional assessment of their lab values, weight relative to their nutritional goals.

There are very few side effects associated with IDPN therapy. Side effects are usually a result of the provision of lipids, or the infusion rate is too high for the patient to tolerate. However, some patients may experience generalized gastrointestinal symptoms such as nausea, vomiting, or diarrhea. Generalized flushing may also occur. These symptoms can be alleviated with our NutriRite Lo™ protocol with an adjustment to the infusion or titration rate of the NutriRite™ IDPN formulation.

IDPN solutions are infused into the venous drip chamber of the venous port in the dialyzer. Caution: The arterial drip chamber should never be utilized to administer IDPN therapy.

If any portion of an NutriRite™ IDPN bag becomes frozen, discard the bag and call Patient Care America to have a replacement bag shipped to the clinic.

Yes. NutriRite™ IDPN has not been associated with causing liver disease nor is it contraindicated in patients with liver disease. Patients with a dysfunctional gastrointestinal (GI) tract who are reliant on parenteral nutrition for all their nutritional needs are at risk for developing parenteral nutrition associated liver disease (PNALD). It is believed that the primary etiology of PNALD is the inability to use the GI tract. Patients receiving NutriRite™ IDPN have a functional GI tract and must consume sufficient oral nutrition to complement the energy and protein in NutriRite™ IDPN in order to meet total nutrient needs. CKD patients with existing liver disease have increased energy and protein requirements due to the addition of another chronic disease. The only time protein may need to be limited is if the patient has hepatic encephalopathy that is sensitive to protein intake.

Yes. The more malnourished a patient becomes the longer it will take to replete the patient and restore a sense of well-being and to positively impact quality of life. When a patient shows signs and symptoms of malnutrition in conjunction with an inadequate nutritional intake that is not improved with oral supplementation, NutriRite™ IDPN should be considered to prevent further deterioration and potential hospitalization. The longer the delay before intervening, the greater the risk of mortality and morbidity.