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Home Artificial Nutrition challenges in times of Covid-19 - patients perspective

For the last few days "Appetite For Life" Association for patients with intestinal failure in Poland was collecting information from our members about present and potential risks related to nutrition care (both enteral and parenteral). The main idea behind this action is our determination to signalize these problems to polish Ministry of Health as soon as possible.

We are aware that situation is different from country to country, but probably some of the problems have an european or even global presence.

The main issues are:

- Continuity of artificial nutrition supply needs to be ensured to hospitals but also to patients homes, as for many of us artificial provision of nutrients is essentinal to sustain our life functions. It does not mean only the complete mixtures, but also all the components. Let me share just one example that EVA TPN bags are mainly manufactured in Italy, what can create shortages and problems in the long term.

- When it comes to delivery of nutrition supply to patients homes, we need to think also about new regulations for the drivers who visits daily 30-40 patients. Of course for his own safety but also patients who are mainly in poor health status and risk group.

- for example, in Poland we have a problem with access to disinfectants, gloves and earloop masks. Situation is different from hospital to hospital, nevertheless the need of following strict aseptic protocols are especially important when it comes to home parenteral nutrition and proper CVC care. There should be a special channel or regulation which secure such products for PN patients in home environment.

- if only possible PN or EN patients infected with COVID-19, should be isolated and have access to skilled medical care not only for treating COVID-19, but also taking proper care of PN/EN access. Unfortunately improper care over these accesses may result in life danger complications, but also when patients are metabolic unstable, constant contact with attending physician and Nutrition Support Team is vital.

- there might be a lack of regulations which precise what will happen if both parents who are taking care over PN/EN paediatric patient, will suffer from COVID-19 and which center will take proper care over the child if somehow child is not infected.

- telemedicine solutions should be used as much as possible to minimize the potential risk of contact with other patients and medical staff in hospitals or outpatient clinic

- there are problems with new admissions to the nutrition units for the patients who needs to start nutrition supplementation. Due to locked and transformed hospitals maybe dedicated outpatient clinic could take this role temporarily.

- maybe not all the lab tests and other examinations needs to be completed during check-up until epidemic situation will be stable again.

Of course we are aware that it covers just a minor part of the problems, but these were collected so far.

Stay safe!

Marek Lichota

Chair of Appetite for Life Association

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