Patients losing gut or gut function due to Crohn’s disease, ischaemia, or abnormal motility can only survive with intravenous feeding. A small number of these patients require lifelong feeding at home. In the 1990s this was not available in Wales, but the home parenteral nutrition network was established and funded in 2004, and in Cardiff, the service started with a handful of patients. As critical care services, and surgical techniques have improved, more and more patients require home intravenous feeding, and the Cardiff Intestinal Failure team now cares for more than 90 patients. The team has grown too and comprises nutrition nurses, gastroenterologists, pharmacists, dieticians, surgeons, and supported by radiologists, biochemists and microbiologists. Our nutrition nurses train patients to care for their own intravenous lines, as preventing line infections is essential for long-term survival. 85% of patients look after their own lines when they leave hospital, reducing dependence on expensive nursing support at home, and infection rates are low at 0.45 / 1000 feed days (about 1 infection every 6 years). Virtually all intestinal failure surgery is performed in Cardiff now.
In awarding the Cardiff service the Gastroenterology Team of the Year award, the judges highlighted excellent multidisciplinary team work; empowerment of patients to become confident in managing their own lines; and outcome measures documenting an extremely high quality service. In accepting the award, Dr Barney Hawthorne, who leads the team, paid tribute to the courage and perseverance of patients who suffer catastrophic loss of gut function, and the dedication of the Cardiff team who are committed to helping them return to as normal and healthy a life as possible.