Hybrid model of compounded and multichamber bag parenteral nutrition for adults with chronic intestinal failure

Abstract

Background Although international guidelines support the use of commercially available multichamber bags (MCBs), the majority of home parenteral nutrition (HPN) in the United Kingdom has been compounded PN, tailored to the patient. However, national capacity limitations in aseptic facilities have necessitated the increased use of MCBs. There are no studies evaluating the appropriateness or benefits of using a “hybrid” regimen incorporating both MCBs and compounded PN in patients already established on compounded HPN. Methods This was a cross‐sectional audit evaluation conducted on September 1, 2021, at a national United Kingdom reference center. All HPN‐dependent adults prescribed HPN for chronic intestinal failure were assessed by a multidisciplinary team for their potential of being switched to a “hybrid” regimen of MCBs and compounded PN. Results Of 180 patients currently receiving compounded HPN that included intravenous nitrogen with glucose ± lipid, 65 (36.1%) were deemed clinically suitable for a hybrid PN regimen, with minimal variance in PN constituents per week (volume 0%, non‐nitrogen kilocalories 0%, nitrogen 0%, fat −0.2%, glucose 0%, sodium 0%, potassium 0%, calcium 0%, magnesium 0%, and phosphate −0.1%) and requiring no additional central venous catheter manipulations. The potential reduction in compounded PN would reduce by 3627 bags per year, equating to a cost saving of £141,453 per year (equivalent to $178,885). Conclusion Wider use of hybrid MCB/compounded HPN regimens could lead to a reduction in the need for compounded PN to be produced by aseptic facilities. Further evaluation of acceptability and tolerance of hybrid regimens by patients already receiving compounded HPN is required.

A scoping review of parenteral requirements (macronutrients, fluid, electrolytes and micronutrients) in adults with chronic intestinal failure receiving home parenteral nutrition

“…When the nitrogen, lipid and glucose content was compared in those with malignant indications for HPN, no difference was observed. 56 When types of HPN were compared, 47,48 standard and individually compound HPN prescriptions varied in nutrient content, although the reasons for this were not evaluated in terms of clinical characteristics.…”

“…Studies reporting HPN composition have indicated that electrolyte requirements differ based on the type of HPN type 47,48 and IF classification, 49,56 but further information is lacking on what drives requirements beyond typical amounts provided by standardised HPN admixtures.…”

“…By contrast, Harrison et al 47 reported 180 out of 230 (71%) of their population from a UK national IF centre receiving individually compounded HPN. This was a theoretical exercise that analysed current prescriptions to see if a hybrid model (combining standard with individually compounded HPN administration across the week) was considered clinically appropriate.…”

“…Clinical factors associated with HPN composition and type were assessed in seven studies. [46][47][48][49][50]56,80 Comparisons across studies and with guideline recommendations were difficult, with some studies reporting total daily amounts rather than amounts per kilogram bodyweight. Not all studies reported all nutrients.…”

“…46 Three studies assessed the type of HPN admixture administered. 47,48,80 In an international Survey of 65 IF Centres conducted by Pironi et al, 80 the type of HPN administered was showed to vary between countries and individual IF centres, with a range of 0%-100% per country using individually compounded bags.…”