A Parenteral Nutrition Use Survey With Gap Analysis

Boullata, Joseph I.; Guenter, Peggi; Mirtallo, Jay M.

doi:10.1177/0148607112464781

Cited by 62 publications

(135 citation statements)

References 44 publications

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“…111 Nearly 75% of respondents in a national survey allow nonnutrient medication to be added to PN admixtures. 112 Most frequently included are insulin, heparin, and the histamine type-2 receptor antagonists. Much less commonly included are albumin, digoxin, dopamine, erythropoietin, furosemide, hydrocortisone, methylprednisolone, metoclopramide, octreotide, and ondansetron.…”

Section: Questionmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

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265

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Background: Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation. Method: A systematic review of the best available evidence was used by an expert work group to answer a series of questions about PN prescribing, order review, compounding, labeling, and dispensing. Concepts from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format were applied as appropriate. The specific clinical guideline recommendations were developed using consensus prior to review and approval by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. The following questions were addressed: (1) Does education of prescribers improve PN ordering? (2) What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration? (3) What are the appropriate calcium intake and calciumphosphate ratios in PN for optimal neonatal bone mineralization? (4) What are the clinical advantages or disadvantages of commercially available premade ("premixed") multichambered PN formulations compared with traditional/customized PN formulations? (5) What are the clinical (infection, catheter occlusion) advantages or disadvantages of 2-in-1 compared with 3-in-1 PN admixtures? (6) What macronutrient dosing limits are expected to provide for the most stable 3-in-1 admixtures? (7) What are the most appropriate recommendations for optimizing calcium (gluconate) and (Na-or K-) phosphate compatibility in PN admixtures? (8) What micronutrient contamination is present in parenteral stock solutions currently used to compound PN admixtures? (9) Is it safe to use the PN admixture as a vehicle for non-nutrient medication delivery? (10) Should heparin be included in the PN admixture to reduce the risk of central vein thrombosis? (11) What methods of repackaging intravenous fat emulsion (IVFE) into smaller patient-specific volumes are safe? (12) What beyond-use date should be used for (a) IVFE dispensed for separate infusion in the original container and (b) repackaged IVFE? (JPEN J Parenter Enteral Nutr. 2014;38:334-377)

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Section: Questionmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

Self Cite

265

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“…New analyses are required to understand the impact of these on complication rates in both PN and EN. Safe practice guidelines for PN have been published [Mirtallo et al 2004], but adherence is poor [Boullata et al 2012;Seres et al 2006]. Safety interventions have resulted in significantly reduced infection rates for central venous catheters [Pronovost, 2008], and the acceptable rate is now zero in hospitalized patients [Kuhn, 2008].…”

Section: Enteral Nutrition and Parenteral Nutrition: Recent Developmentsmentioning

confidence: 99%

Advantages of enteral nutrition over parenteral nutrition

Seres

Valcárcel

Guillaume

2012

Therap Adv Gastroenterol

125

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It is a strong and commonly held belief among nutrition clinicians that enteral nutrition is preferable to parenteral nutrition. We provide a narrative review of more recent studies and technical reviews comparing enteral nutrition with parenteral nutrition. Despite significant weaknesses in the existing data, current literature continues to support the use of enteral nutrition in patients requiring nutrition support, over parenteral nutrition.

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“…At the time of the survey, only 22% had access to a multi‐oil ILE product (ie, SMOFlipid), with the majority using pure soybean oil ILE in the United States. These data differ slightly from a 2011 survey, which reported that 28% used 3‐in‐1 and 45% used 2‐in‐1 compounded PN in adult patients . It was of great interest to note that only 5 or fewer PN admixtures were prepared by those institutions caring for 50% of adults, 82% of pediatrics, and 64% of neonates .…”

Section: Ile Preparationmentioning

confidence: 62%

“…These data differ slightly from a 2011 survey, which reported that 28% used 3‐in‐1 and 45% used 2‐in‐1 compounded PN in adult patients . It was of great interest to note that only 5 or fewer PN admixtures were prepared by those institutions caring for 50% of adults, 82% of pediatrics, and 64% of neonates . Of the 16% minority using commercial MCB PN products in the United States, nearly 5% add separate ILEs to their 2‐chambered PN .…”

Section: Ile Preparationmentioning

confidence: 73%

“…Several concerns exist with the compounding of PN. Firstly, 23% of pharmacist respondents to the US national survey indicated that they work at organizations where no pharmacist is dedicated to review PN orders . Aside from performing the clinical review to double‐check the appropriateness of indication and nutrient dosing, the reviewing pharmacist should evaluate the prescribed formulation for compatibility of each ingredient with all other ingredients, and the stability of the final TNA emulsion.…”

Section: Ile Preparationmentioning

confidence: 99%

See 1 more Smart Citation

Use of Intravenous Lipid Emulsions With Parenteral Nutrition: Practical Handling Aspects

Boullata

Berlana

Piętka³

et al. 2020

J Parenter Enteral Nutr

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A number of topics important to the handling of intravenous lipid emulsions (ILEs) were discussed at the international summit. ILE handling includes the preparation and the administration steps in the typical use of parenteral nutrition (PN). The discussion and consensus statements addressed several issues, including standardization of the PN process, use of commercially available multi‐chamber PN or compounded PN bags, the supervision by a pharmacist with expertise, limiting ILE repackaging, and infusion duration.

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A Parenteral Nutrition Use Survey With Gap Analysis

Abstract: The survey data are a valuable snapshot of current practices with PN. Poor compliance with some of the safe practice guidelines continues. This will help guide new safety initiatives for the PN use process.

Cited by 62 publications

References 44 publications

A.S.P.E.N. Clinical Guidelines

A.S.P.E.N. Clinical Guidelines

Advantages of enteral nutrition over parenteral nutrition

Use of Intravenous Lipid Emulsions With Parenteral Nutrition: Practical Handling Aspects

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