A Usage Evaluation of Total Parenteral Nutrition in Pediatric Patients

Abstract

Records of 20 consecutive pediatric patients receiving total parenteral nutrition over a 1-month period were reviewed for appropriateness of nutritional assessment and management. Each patient was monitored until total parenteral nutrition was discontinued or for a maximum of 2 weeks. A total of 124 therapy days were reviewed. Results demonstrated that only 35% of these patients had a nutritional assessment performed prior to initiation of therapy, and only 65% had nutritional goals determined. Nutritional goals were defined as patient-specific goals for fluid volume (FV), calories, protein, and fat emulsion. Analysis of data demonstrated that goals for FV were met on 62% of therapy days. Of the days on which FV goals were met, goals for calories, protein, and fat emulsion were met on 54%, 59%, and 51% of therapy days, respectively. Baseline serum triglyceride levels were measured in one of 20 patients. Serial laboratory monitoring was adequate, with the exception of hepatic enzymes and serum triglycerides, which were measured in 14 and 9 patients, respectively. Recommendations for pediatric parenteral nutrition therapy are discussed, as well as methods to implement these recommendations.

Evaluation of parenteral nutritional support in the surgical and medical wards of a referral teaching hospital

“…Serum albumin levels and hepatic enzymes that are recommended to be monitored as weekly intervals were assessed more frequently in 35% of the patients. In another study conducted by Macfarlane et al the same results were obtained [16]. These differences may somewhat related to the recommendations.…”

“…The most common problem related to pharmaceutical preparation of PN formulations is day-to-day changes of patients' nutritional requirements following changing in their clinical and physiological conditions [16,19-21]. Improving the quality of patients' metabolic supports can be achieved with adequate nutritional assessment using a standard protocol.…”

“…In more than 80% of the patients these parameters were monitored semiweekly. It may be related to limited laboratory facilities, nursing staff workload, and patient's preferences [16,27]. …”

“…ASPEN guidelines recommend the weekly monitoring of these values as it is simple, less expensive and requires less-frequent blood sampling. This criterion should be changed if patient's clinical condition needs close monitoring [4,16]. …”

“…For prevention of these errors, appropriate evaluation of patient's metabolic needs, ordering, preparation, administration and monitoring of PN is essential. Nutritional support team is responsible for evaluation and calculation of patient's metabolic needs, selecting appropriate route of nutritional support, ordering patient's specific admixture, and patient's monitoring for efficiency and complication of nutritional support [16-18]. The purpose of this study was evaluation of PN services in the surgical and medical wards of a referral teaching hospital, Tehran, Iran.…”