Reussir une nutrition parenterale a domicile (NPAD) depend de la volonte et de la competence de tous ses acteurs. Initialement, la qualite de l'interface entre l'equipe medicale d'accueil et le malade et son entourage est essentielle en vue de l'apprentissage des notions indispensables a une bonne pratique de la NPAD. L'attention permanente des pharmaciens hospitaliers et, le cas echeant, du faconnier constitue une garantie indispensable de la qualite des melanges nutritifs administres. Une surveillance et une reevaluation reguliere des benefices et/ou des inconvenients ou effets secondaires de la NPAD est necessaire. De ce fait, une attention multidisciplinaire (medicale, pharmaceutique, logistique) « au quotidien » est la meilleure garantie pour une NPAD sure et efficace.

Background/Aim and Method: Severe malabsorption often necessitates prolonged parenteral nutrition. Home parenteral nutrition (HPN) offers the opportunity for treatment at home. We report clinical and laboratory data of initial 27 HPN patients of one center since its opening in 1994. Results: Clinical and biological markers of nutritional status were normalized and well maintained in most patients. Except for vitamin E and selenium (lower in HPN patients), the other vitamin and micronutrient levels were normal. There was no obvious essential fatty acid deficiency. Cholestasis was usual, but only 1 patient had a severe hepatic disease. Catheter infection occurred 18 times in 13 patients, but the frequency decreased with time (from 4.2 to 1.7 infections/1,000 days on HPN). No patient died from HPN complications. Social rehabilitation and, in some patients, full professional rehabilitation were constant. Conclusions: These data confirm that HPN performed in centers with expertise allowed patients to overcome gut failure and to recover subnormal or normal nutritional status. Satisfactory social rehabilitation was obtained in all patients. HPN complications were rarely life-threatening, and their frequency decreased with experience.