Parenteral Nutrition on tour

Destination

You should choose countries or places of with high hygienic standards and definitely try to avoid those without access to running water and sanitation facilities, which can significantly contribute to the increased risk of catheter related bloodstream infection (CRBSI).

If possible, you should not choose places where the temperature is too high or too low, as this will expose your body to extreme climate conditions. Additionally, hot climate and high humidity may result in greater fluid intake needs, due to sweating.

It is also good to know before you leave whether there is a Parenteral Nutrition Centre in a given country or near your destination, which will make you feel safer in case of any complications.

Type of accommodation

The availability of sanitary facilities in the room should always play a decisive role while choosing a type of accommodation. This will enable safe connecting and disconnecting of nutritional formulas and proper care of the catheter in accordance with recommendations. Additionally, if your nutritional formulas must be stored at a refrigerated temperature, you need to make sure that there is a refrigerator in the room (not a mini-bar!), or whether it is possible to store the bags in another place with an appropriate temperature. While planning, you should  investigate as many details as possible, which may prove to be crucial for ensuring the safety of your nutritional formula supply and your good mood (i.e. cleanliness in the hotel,  access to an elevator, parking, food quality).

Length of stay

The length of your stay depends on the number of nutritional formulas and dry equipment which you will need during your stay. This directly affects the size of additional baggage that you will have to take with you. If you use compounding bags, you should take the bags’ expiration period into account, which is relatively short. If you wish to stay for an extended period, you should consider using multi-chamber bags. You should always have a sufficient reserve of the necessary equipment in the event of unexpected circumstances.

Travel companion

If you do not plan to travel with your family, you should try to organize your journey together with your friends and acquaintances, if possible, so that they may help you in the event of unforeseen circumstances. If you are travelling alone, you should always inform your relatives of your plans and where you will be staying.

You should consult your doctor about your travel plans and inform them of  your planned location and duration of stay. The specialist will advise you whether your current state of health is adequate for the planned trip. It is a good idea to ask about the centre or specialist closest to  your destination, to know where to turn and ask for help if necessary.

You should remember to ask your doctor to sign/write an appropriate medical certificate which will  include information about your type of nutritional therapy, its importance in maintaining vital functions and the medical equipment that you will need during your stay (please find attached a sample of such a certificate).

It is advisable to transport your nutritional formulas in consultation with the nutritional centre. There are different reimbursement systems and a range of services covering delivery of your nutritional formulas in various countries. It is a good idea to ask your nutrition centre if it is possible to deliver nutritional formulas directly to the place you intend to stay.

If this is not possible,  all or part of your equipment (especially the dry component) can be sent by courier service at your own expense. This will avoid you needing extra baggage, especially when you travel around the country and do not have your own means of transport.

Pros

• The fastest way to travel, especially over long distances
• Enables us to reach almost every place in the world within 48 hrs.
• If you need special assistance, there is a range of services to help you at the airport and on board.

Cons

• Limited checked baggage
• You need to inform the airline about your excess baggage in advance
• It is not possible to make a stop in case you feel unwell
• You need to plan extra time for check-in to follow all non-standard procedures

Before your journey, remember to prepare :

• Medical certificate –essential during all stages of your trip
• Visit or call the airline’s customer service in advance to inform them about your special requirements and excess baggage.        

There are different regulations and policies concerning medical equipment. The airlines are not obliged to take extra baggage free of charge. Nevertheless, it is a common situation to allow PN patients to carry medical luggage without additional cost. Our aim is to emphasize the importance of the products which you need to take with you.

• Politely ask customer service for permission to take on extra luggage free of charge. You can use information from your medical certificate and stress that PN and your medical equipment is essential in order to sustain your vital functions
• Ensure that the customer service representative adds the appropriate information to your flight record
• If there is such an option, you should ask for a medical baggage waiver letter (attached). It will include the item description, weight and dimensions of each box.
• It is not a general rule, but even low-fare airlines allow people to take excess medical luggage (attached file).
• Always remember to write down the name of the person with whom you speak.

Medical supplies

• Pack all of your medical supplies tightly and carefully; try to fill up free space with bubble wrap
• Inform ground staff that your luggage must be handled with proper care
• Put “Fragile & Handle with care” labels on the boxes
• Keep one or two days’ worth of supplies and medicines with you on the plane. This gives you a safety margin if your supplies are delayed.
• In consultation with your hospital or nutrition centre, ensure that your nutritional formulas and medical equipment won’t be affected by X-ray radiation at the airport. Potential for dangerous radiation exposure from backscatter machines is low enough that it doesn't pose a significant risk, but it is worth asking in advance.

If you are a frequent flyer, FREMEC makes your journeys easier. The Frequent Traveller's Medical Card (FREMEC) was developed for frequent flyers with disabilities. The card contains all the important information related to your care. The card may be issued by any airline which is a member of the International Air Transport Association (IATA). The card’s validity is based on your medical history.

Pros

• You can pack all your nutrition equipment at the starting point when you leave and it will arrive at your final destination without extra effort or needing to be re-packed.
• You are able to control when and for how long you wish to make a stop.
• You can use your own car during your stay at your final destination.

Cons

• You must be focused on the road at all times.
• Traveling over long distances can be tiring and dehydrating.
• Depending on the distance, the journey might take longer compared to an airplane. 
• you must maintain proper temperature of the TPN bags during this period of time.  

Before your journey, remember to prepare :

• If there is a need for an overnight stay, choose accommodations in advance. Ask if there is a fridge in the room. Do not forget to put ice packs in the freezer.  
• Plan how you will administer your PN if necessary.
• Pack all necessary items for one procedure in one place, to avoid unnecessary unpacking.
• A portable fridge or cooler will be necessary  to maintain the proper temperature of TPN bags during your journey. 
• A medical certificate as well as a disabled parking card are essential. 

Pros

• You are not responsible for driving, which allows you to do something else or take time to relax.
• Toilets are available in the majority of trains / long distance buses.
• More cost-effective if you travel alone.

Cons

• You have to carry on medical and non-medical luggage to/from the station.
• Travelling over long distances might can be tiring and dehydrating.

Before your journey, remember to prepare :

• Check baggage limits. 
• Inform the bus or train company about your needs and extra luggage in advance.
• Make sure that there is a toilet on board.
• Keep an emergency kit and medical information with you.