Supplementations of industrial multichamber parenteral nutrition bags in critically ill children: Safety of the practice

Abstract

Background: Parenteral nutrition (PN) is sometimes required in critically ill children because of contraindication or intolerance to full enteral nutrition. European guidelines recommend favoring multichamber bag PN (MCB PN), when possible, for quality purposes and ease of use. The prescribers may adjust the MCB PN through supplementations to better fulfill patient needs.The objective of this study is to investigate the use and supplementations of MCB PN.Methods: This observational, single-center, retrospective study was conducted in a pediatric intensive care unit (PICU). We collected prescriptions of MCB PNs and their supplementations added directly into PN bags. A descriptive analysis and a comparison of electrolyte supplementations with the manufacturer's recommendations were undertaken.Results: One hundred thirty-five children (median age 39.2 months [7.0-118.8]) were included, 1449 MCB PNs were administered, and 1652 supplementations were carried out in 736 PN bags. Thirty-two percent of supplementations were vitamins, 32.2% were trace elements, and 35.8% were electrolytes. Around 10% of electrolyte supplementations in PN bags were outside the manufacturer's recommendations. These nonconformities primarily concerned phosphate. Conclusion: This study showed the real-world clinical use of MCB PN in the PICU. Proper attention should be paid to septic risks and physicochemical risks to ensure efficient practice and safety of MCB PN use.

National evaluation of harm associated with patient safety incident reports related to the provision of parenteral nutrition to patients, using a national incident reporting system

“…In the UK, it is recommended that additions to PN bags, including multichamber bags, only occur in the pharmacy aseptic unit 40 . This may vary in other parts of the world, and studies have described the supplementation of micronutrients and/or electrolytes to multichamber bags in a clinical setting 41–43 . This difference in practice should be considered when comparing incident rates in other countries.…”

“…40 This may vary in other parts of the world, and studies have described the supplementation of micronutrients and/or electrolytes to multichamber bags in a clinical setting. [41][42][43] This difference in practice should be considered when comparing incident rates in other countries. Extravasation injuries, patient age of <1 year, and venous access devices were predominant factors for administration incident reports of moderate/severe harm or death.…”