Parenteral nutrition compatibility and stability: A comprehensive review

Boullata, Joseph I.; Mirtallo, Jay M.; Sacks, Gordon S.; Salman, Genene; Gura, Kathleen M.; Canada, Todd W.; Maguire, Angela

doi:10.1002/jpen.2306

Cited by 35 publications

(54 citation statements)

References 157 publications

(440 reference statements)

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“…During storage and administration, PN admixtures should be protected from light due to the photodegradation of some nutrients [ 6 , 37 , 38 , 39 ]. In fact, there is general agreement to recommend photoprotection in PN for the pediatric population due to toxic degradation of PN ingredients (mainly lipids and vitamins) linked to adverse effects [ 40 , 41 , 42 ].…”

Section: Vascular Access and Administrationmentioning

confidence: 99%

“…However, this recommendation should also be extended to PN for adults, since components used for adults are also susceptible to photo-oxidation. Moreover, the use of multilayered bags is also recommended to prevent oxidation [ 37 , 39 , 43 ].…”

Section: Vascular Access and Administrationmentioning

confidence: 99%

“…In addition, electrolytes and nutrients, such as glutamine or omega-3 fatty acids, can be added to MCBs because these criteria have been considered in the development of MCB formulations. In contrast, by prescribing and compounding a tailored PN, it has been claimed that final macronutrient concentrations should be as follows: amino acid ≥ 4%, dextrose ≥ 10%, and lipids ≥ 2% to keep the admixture stable [ 37 ]. However, these recommendations do not agree with macronutrient concentrations recommended for PPN formulations.…”

Section: Composition Of Pn Admixturesmentioning

confidence: 99%

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Parenteral Nutrition Overview

Berlana

2022

Nutrients

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Parenteral nutrition (PN) is a life-saving intervention for patients where oral or enteral nutrition (EN) cannot be achieved or is not acceptable. The essential components of PN are carbohydrates, lipids, amino acids, vitamins, trace elements, electrolytes and water. PN should be provided via a central line because of its hypertonicity. However, peripheral PN (with lower nutrient content and larger volume) can be administered via an appropriate non-central line. There are alternatives for the compounding process also, including hospital pharmacy compounded bags and commercial multichamber bags. PN is a costly therapy and has been associated with complications. Metabolic complications related to macro and micronutrient disturbances, such as hyperglycemia, hypertriglyceridemia, and electrolyte imbalance, may occur at any time during PN therapy, as well as infectious complications, mostly related to venous access. Long-term complications, such as hepatobiliary and bone disease are associated with longer PN therapy and home-PN. To prevent and mitigate potential complications, the optimal monitoring and early management of imbalances is required. PN should be prescribed for malnourished patients or high-risk patients with malnutrition where the feasibility of full EN is in question. Several factors should be considered when providing PN, including timing of initiation, clinical status, and risk of complications.

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Section: Vascular Access and Administrationmentioning

confidence: 99%

Section: Vascular Access and Administrationmentioning

confidence: 99%

Section: Composition Of Pn Admixturesmentioning

confidence: 99%

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Parenteral Nutrition Overview

Berlana

2022

Nutrients

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“…Beim stabil wachsenden Frühgeborenen wird dann ein molares Ca/Pho-Verhältnis von ca. 1,3:1 empfohlen 24 25 (dabei jeweils in den Grenzen 1,6–3,5 mmol/kg/d (64–140 mg/kg/d Kalzium, 50–108 mg/kg/d Phosphat). Eine Gabe in dieser Konzentration ist nur über zentral liegende Venenkatheter möglich.…”

Section: Substitutionsprinzipien Zur Präventionunclassified

Die Frühgeborenenosteopenie – Pathophysiologie und Diagnostik

Matheisl¹,

Kidszun²

2022

Neonatologie Scan

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“…The physicochemical stability of a lipid emulsion is an important characteristic that depends on factors such as temperature, pH, exposure to light and oxygen, peroxidation, the presence of vitamins and trace elements, the presence and relative concentration of divalent ions, and the type of container [5]. Stability issues become more complex when amino acids, vitamins, trace elements, electrolytes, or carbohydrates are added for parenteral nutrition [6].…”

Section: Considerations For the Manufacturing Of Parenteral Lipid Emu...mentioning

confidence: 99%

Process Analytical Technology for the Production of Parenteral Lipid Emulsions According to Good Manufacturing Practices

Grumbach

Czermak

2022

Processes

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The good manufacturing practices (GMP) and process analytical technology (PAT) initiatives of the US Food and Drug Administration, in conjunction with International Council for Harmonisation (ICH) quality guidelines Q8, Q9, and Q10, ensure that manufacturing processes for parenteral formulations meet the requirements of increasingly strict regulations. This involves the selection of suitable process analytics for process integration and aseptic processing. In this article, we discuss the PAT requirements for the GMP-compliant manufacturing of parenteral lipid emulsions, which can be used for clinical nutrition or for the delivery of lipophilic active ingredients. There are risks associated with the manufacturing processes, including the potential for unstable emulsions and the formation of large droplets that can induce embolisms in the patient. Parenteral emulsions are currently monitored offline using a statistical approach. Inline analytics, supplemented by measurements of zeta potential, could minimize the above risks. Laser scanning technology, ultrasound attenuation spectroscopy, and photo-optical sensors combined with image analysis may prove to be useful PAT methods. In the future, these technologies could lead to better process understanding and control, thus improving production efficiency.

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Parenteral nutrition compatibility and stability: A comprehensive review

Cited by 35 publications

References 157 publications

Parenteral Nutrition Overview

Parenteral Nutrition Overview

Die Frühgeborenenosteopenie – Pathophysiologie und Diagnostik

Process Analytical Technology for the Production of Parenteral Lipid Emulsions According to Good Manufacturing Practices

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