September 2011 Issue
By Maura Keller
Vol. 13 No. 9 P. 26
For patients receiving enteral nutrition (EN) and parenteral nutrition (PN), traveling across the globe—or even close to home—is part art, part science, and plenty of hard work. In a world without boundaries, enteral or parenteral patients who travel must contend with a complex set of requirements. But with guidance from their dietitians and other healthcare providers, these individuals can set their sights on their favorite destinations both near and far.
What to Know Before You Go
Quality of life is an important consideration for patients receiving EN or PN, and many practitioners believe nutritional requirements should not hold back patients from traveling if, from their physician’s perspective, they are medically able.
“Although travel may require more packing and preparation, it’s not impossible,” says Mandy Corrigan, MPH, RD, CNSC, a nutrition support clinician at the Digestive Disease Institute at Cleveland Clinic. “PN patients should start thinking about all of the supplies they’ll need to take ahead of time and make a list. It may be difficult to not overpack supplies, but patients should account for delays in travel and have at least an extra day’s worth of supplies with them. Patients can use the travel letter their home PN physician provides as a reminder of the supplies they’ll need.”
Refrigeration is also a concern, as some PN treatments must be kept cool to preserve the contents and avoid degradation. This can be particularly challenging if the patient is traveling by bus, train, or car, which have limited and often unrefrigerated storage spaces, according to Mark DeLegge, MD, a medical director for Baxter and former director of the Digestive Disease Center at the Medical University of South Carolina. For short car trips, patients can use ice chests to refrigerate their therapy.
Preparing for Airport Security
There are several other challenges enteral and parenteral patients may face when traveling related to the medically necessary supplies and life-sustaining therapy they must carry with them on a trip.
“For example, nutrition support often requires large amounts of liquid therapy and equipment, such as medical sharps, which can be difficult to take through security,” DeLegge explains. “Fortunately, security organizations such as TSA [Transportation Security Administration] are becoming much more accustomed to seeing patients travel with medical supplies. To make the process even more seamless, the traveler should carry a cover letter from his or her physician [or dietitian] on official letterhead, explaining the condition and treatment in consumer-friendly terms to help expedite the security process.
“While you and your patient are familiar with the condition and treatment, travel officials may not be, and this additional context may help to ensure a more seamless travel process for your patient,” DeLegge adds.
Kathy Barco, RD, LD, CNSC, an intestinal rehabilitation and transplant dietitian at the Digestive Disease Institute Center for Human Nutrition at the Cleveland Clinic, recommends enteral patients also carry a letter from their physician that explains their feeding requirements, the prosthetic devices they entail (such as the tube that may interfere with some screening equipment), and the need for supplies on their person (including bottled water, syringes, cans of formula, feeding bags, pumps, pump sets, and medications).
Another suggestion: ship supplies ahead. “Ship whatever you can to your destination in advance,” Barco says. “This could include formula, bags, bottled water, and pump sets. Your home care company may be able to assist with this. Be sure to include a copy of your travel itinerary and your name and number inside all shipped packages.”
“Supply availability and access also can be challenging, especially if the patient is traveling to multiple destinations or for an extended period of time,” DeLegge says. “In this case, it may be better to have treatment and supplies shipped ahead of time through a patient’s home healthcare provider. This can make spontaneous travel more difficult. Treatment needs should be coordinated with your physician and home care provider well enough in advance of travel to ensure adequate therapy arrives safely to your destination.”
Heading Off Tube Problems
Barco says patients should be prepared for problems with their tube. For instance, the tube may clog (obtain a prescription for Clog Zapper in advance) or it may fall out. If this happens, a trip to the emergency department may be necessary for replacement, especially for patients who are 100% reliant on the tube for nutrition and hydration.
Patients should have a printed copy of directions for operating the pump in case they require the assistance of an untrained person along with a copy of the home enteral feeding prescription and instructions.
Bring an extra battery for the pump and/or bring a recharger. If traveling out of the country, check to see whether a special electrical adaptor is necessary.
Patients should be knowledgeable about the area they’re visiting and identify in advance the location of a local hospital in case they have tube malfunctions or become ill. They also should carry a list of all their medications as well as the phone number of their pharmacy and physician in case they need to call while they’re away.
DeLegge recommends patients work with their clinicians, dietitians, and home healthcare companies to research policies and product availability ahead of time, particularly when traveling internationally.
“Products available in the U.S. may not be available abroad, and a healthcare provider may need to work with local resources to ensure your treatment will be available upon your arrival,” DeLegge says. “Likewise, those traveling both abroad and to remote areas need to assess electrical needs and capabilities. If traveling overseas, a patient likely will need to plan ahead for how to overcome the issue of running a pump on an electrical system that’s different from what is used in the U.S.”
Also, depending on the length of a vacation, arrangements may need to be made with a local laboratory or hospital to have routine laboratory studies drawn.
“If at all possible, the team managing the PN always tries to avoid laboratory studies during travel,” Corrigan says. “The home PN patient should contact the clinician managing PN early on so these arrangements can be made or to see if the laboratory studies can be adjusted to be drawn either before travel or upon the return home.”
Patients traveling via airplane domestically or internationally may seek the advice from those who have done this in the past. “Patients receiving home PN usually desire to help others that also are receiving this therapy,” Corrigan says. “We encourage home PN consumers to share their experiences with others to make travel easier.”
Patients can contact the Oley Foundation (www.oley.org) or the physician or pharmacy managing their feeding needs to get the contact information of patients that have traveled in the past.
— Maura Keller is a Minneapolis-based writer and editor.
Common mistakes enteral and parenteral patients may make when traveling include the following:
• planning at the last minute;
• skipping days of therapy without consulting a physician;
• not having a back-up plan in case of an emergency; and
• inadvertently compromising a compounded parenteral nutrition solution by not refrigerating it.