You may want to start having either a podiatrist or perhaps a home care nurse do your toenails. Being a former home care nurse, I can tell you that even the nursing assistants were not allowed to cut the toenails of people with diabetes, an RN had to do it. Some agencies actually have 'foot care clinics' where you can come in and have an RN do that care. With PN, especially with vascular insufficiency, not to mention immunosuppressive therapy, you are at higher risk of losing toes or feet, just like a diabetic. I would take a look at diabetic foot care information and would consider getting a 'higher' level of care where nail care is involved.

PN is PN regardless of the source, and one of the reasons that diabetics have the complications of 'diabetic neuropathy' has nothing to do with the actual diabetes, but rather to do with the chemistry of PN.

With PN, regardless of how much a given individual's feet may hurt, they are unaware of injuries to their feet.