Evolution of the technique of home parenteral nutrition.

Experience with use of the artificial kidney in the home led to the concept of self-infusion of parenteral nutrients at home. Originally called an artificial gut, the term has been changed to home parenteral nutrition. The original method proposed for circulatory access, a side-arm on an A-V shunt, failed and forced the development of a right atrial catheter which proved to be both safe and longlasting. A safe and rapid self-mix system of nutrient preparation was developed which made the patient independent of the hospital pharmacy. A wearable infusion device proved workable but was abandoned because it was unnecessary and greatly interfered with patient rehabilitation. A portable infusion system has been developed which facilitates patient mobility during infusions as well as patient travel.