Intestinal failure program
How the program works
Intestinal rehabilitation is the coordinated medical, nutritional, surgical, psychosocial, and catheter-care strategy used to promote intestinal adaptation, reduce complications, and improve long-term outcomes.
Program goals
- Maximize intestinal adaptation and absorption of nutrients and fluid
- Reduce or eliminate dependence on parenteral nutrition and IV fluid support where feasible
- Prevent and promptly manage catheter, hepatic, metabolic, renal, and micronutrient complications
- Improve growth in children, and functional status and quality of life in all patients
- Ensure safe transition to home parenteral nutrition using competency-based education
- Identify candidates for bowel reconstruction, bowel-lengthening procedures, and transplant referral
What the program includes
Initial assessment
Every new patient has a comprehensive baseline evaluation before major changes are made to nutrition support: diagnosis and anatomy, operative history, colon continuity, stoma and fistula characteristics, weight trajectory, oral and enteral intake, output and hydration, venous access history, prior infections and thrombosis, micronutrient history, medications, and readiness for home support.
Anatomy-based risk stratification
Clinical risk and management strategy vary significantly with anatomy. Patients are categorized as end jejunostomy or high-output stoma, jejunocolic anatomy with colon in continuity, or jejunoileal anatomy with a preserved ileocecal valve or terminal ileum.
Nutrition management
Enteral intake is advanced as early and safely as feasible, with oral intake preferred when appropriate. Parenteral prescriptions are individualized for energy, protein, fluid, electrolyte, and micronutrient needs, adjusted to organ function, output losses, and laboratory trends. Cyclic PN is used when clinically appropriate.
Medication strategy
Antimotility agents, acid suppression, selective bile-acid binders, pancreatic enzymes, and treatment for small intestinal bacterial overgrowth, tailored to anatomy and symptoms. Candidacy for GLP-2 analogue therapy is reviewed against anatomy, current dependence, output, weight trend, organ function, and treatment goals.
Central venous access
A line-preservation-first philosophy: access-site planning, standard insertion and maintenance bundles, hub disinfection, dressing standards, minimized unnecessary access, and competency validation for everyone who handles the line. Fever, rigors, unexplained hypotension, or a catheter-site abnormality triggers urgent evaluation.
Monitoring and surveillance
An organized schedule covering hydration, liver and renal function, electrolyte balance, bone and mineral health, micronutrient status, catheter complications, and functional outcomes. Monitoring is most intensive at initiation, after discharge, after surgery, and during any nutrition or medication change.
Hospital-to-home transition
No patient with a diagnosis of intestinal failure is discharged on home parenteral nutrition until metabolic stability, patient or caregiver competency, venous access readiness, home logistics, and follow-up plans are fully documented.
Discharge readiness includes a finalized nutrition care plan, a stable electrolyte profile, functioning venous access, home-infusion coordination, written emergency instructions, and demonstrated ability to perform setup, aseptic technique, pump management, troubleshooting, and emergency response.
Escalation pathways
| Pathway | When it is used |
|---|---|
| Multidisciplinary conference | New referrals, unstable patients, catheter infections, PN adjustments, surgical candidates, and transplant consideration. Action items are documented and assigned. |
| Surgical review | Early review for patients whose anatomy or complications may benefit from reconstruction, bowel lengthening, fistula repair, ostomy revision, or correction of obstruction. |
| Transplant referral | Early referral for progressive PN-related liver dysfunction, recurrent life-threatening catheter sepsis, depletion of central venous access, or inability to maintain health despite optimized care. |
| Specialty co-management | Hepatology, nephrology, infectious diseases, wound and ostomy services, behavioral health, and interventional radiology, as needed. |
Service boundary. AIRI does not prescribe or longitudinally manage controlled substances. We assess symptoms, identify safety concerns, reconcile medications, communicate with the established prescriber, and coordinate referral to pain management, addiction medicine, or psychiatry when clinically indicated.
The care team
AIRI operates as a formal multidisciplinary program with written leadership accountability, scheduled case review, and defined cross-coverage.
| Role | Responsibility |
|---|---|
| Medical Director / physician | Clinical oversight, acuity decisions, medical necessity, specialty referral approval, PN and HPN plan, escalation |
| Nurse practitioner | Initial clinical review, follow-up care, medication reconciliation, referral support within scope |
| AIRI registered nurse | Safety triage, line assessment, laboratory tracking, home-care coordination, education, escalation |
| Referral coordinator | Referral intake, records, authorization, scheduling, tracker maintenance, closed-loop referral confirmation |
| Social worker | Transportation, benefits, housing, caregiver support, refrigeration and electricity, language access, home-service logistics |
| Dietitian / nutrition support | Nutrition assessment, PN and enteral review, patient education, monitoring coordination |
| Home-health nurse | Home assessment, line care, dressing changes, technique reinforcement, prompt escalation |
| Pharmacy / home infusion | PN dispensing, supply and delivery coordination, pharmacy clinical review, authorized communication of results |