According to CMS, which of the following is an indication for home parenteral nutrition (HPN)?

• A. Bowel resection resulting in 5 feet small bowel beyond the ligament of Treitz
• B. Gastrointestinal losses totaling 20% of oral intake
• C. Need for bowel rest of 1-2 weeks duration
• D. Failure to maintain weight on an oral diet

Answer: (A)

Long-term parenteral nutrition is indicated when there is chronic intestinal failure — meaning the gut can’t absorb enough nutrients to meet the body’s needs, even with oral or enteral intake. A bowel resection that leaves about five feet of small intestine beyond the ligament of Treitz represents a substantial loss of absorptive surface. With such a short remaining length, nutrient absorption is severely impaired, and the patient often cannot meet energy, protein, and fluid needs from the gut alone. This is a classic scenario where home parenteral nutrition is indicated, to maintain nutrition while the gut adapts or while longer-term strategies are pursued.

The other scenarios don’t meet CMS criteria for starting long-term parenteral support. Moderate gastrointestinal losses of 20% of oral intake can sometimes be managed with optimization of oral/enteral nutrition. A short bowel rest period of 1–2 weeks is temporary and not a persistent inability to absorb nutrients. Failure to maintain weight on an oral diet may occur for various reasons and does not by itself prove chronic intestinal failure requiring home PN without contemplating absorption capacity and reliance on PN.