{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T06:27:04Z","timestamp":1787034424870,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nut in Clin Prac"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2010income countries is limited. This study describes an 11\u2010year experience of a structured, nursing\u2010led HPN program within Brazil's Unified Health System (SUS), reporting the program model and catheter\u2010related safety outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective observational cohort study including 20 adults with CIF followed between January 2014 and December 2024. The primary outcome was catheter\u2010related bloodstream infections (CRBSI) incidence density per 1000 catheter\u2010days (exact Poisson 95% confidence interval [CI]). Secondary outcomes included mechanical complications, hospital readmissions, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across 81 central venous catheters and 45 046 catheter\u2010days, 13 CRBSI episodes occurred (incidence density 0.29\/1000 catheter\u2010days; 95% CI: 0.15\u20130.49). An additional 12 local catheter infections not meeting CRBSI criteria were recorded, yielding an overall catheter\u2010related infection rate of 0.55\/1000 catheter\u2010days. Median pre\u2010discharge nursing training was 23 days. Gram\u2010positive 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\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings support the feasibility of safe long\u2010term HPN delivery in resource\u2010constrained public healthcare settings and describe a replicable implementation model encompassing structured multidisciplinary care, formalized nursing\u2010led training, and graduated post\u2010discharge follow\u2010up. The subsequent incorporation of HPN into Brazil's national health policy adds real\u2010world relevance to this experience.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ncp.70171","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T06:00:12Z","timestamp":1787032812000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A structured multidisciplinary home parenteral nutrition program in a public healthcare system: Implementation model, nursing\u2010led training protocol, and 11\u2010year safety outcomes"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7884-6607","authenticated-orcid":false,"given":"Tatiana","family":"da Cunha Rana","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Faculdade de Medicina, Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0813-7525","authenticated-orcid":false,"given":"Mariana Hollanda Martins","family":"da Rocha","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Faculdade de Medicina, Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7607-7168","authenticated-orcid":false,"given":"Luiz Augusto Carneiro","family":"d'Albuquerque","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Faculdade de Medicina, Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2315-6944","authenticated-orcid":false,"given":"Andr\u00e9 Dong Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Faculdade de Medicina, Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5162-138X","authenticated-orcid":false,"given":"Wellington","family":"Andraus","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Faculdade de Medicina, Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0202-9037","authenticated-orcid":false,"given":"Luciana Bertocco","family":"de Paiva Haddad","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Faculdade de Medicina, Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"issue":"2","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.clnu.2016.01.020","article-title":"ESPEN guidelines on 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