Type and Prevalence of Adverse Events During the Parenteral Nutrition Cycling Process in Patients Being Prepared for Discharge

Suryadevara, Sreenija; Celestin, Jackie; DeChicco, Robert; Austhof, Sandra I.; Corrigan, Mandy L.; Speerhas, Rex; Steiger, Ezra

doi:10.1177/0884533611434325

Cited by 15 publications

(17 citation statements)

References 9 publications

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“…Since this time, considerable clinical and research efforts in a variety of hospitalized patient populations have been pursued to improve hyperglycemia management and consequently acute hospital outcomes. PN, a supportive care therapy commonly utilized in the SCT patient population, is associated with hyperglycemia 7-9 . In a heterogenous cohort of SCT recipients, those who received PN experienced a higher incidence of infection and significant delays in WBC and platelet engraftment for autologous (p=0.01) and allogeneic (p=0.02) donor types when compared to non-PN recipients 10 .…”

Section: Introductionmentioning

confidence: 99%

Incident hyperglycemia, parenteral nutrition administration and adverse outcomes in patients with myeloma admitted for initial auto-SCT

Sheean

Kilkus

Liu

et al. 2013

Bone Marrow Transplant

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Parenteral nutrition (PN) exacerbates hyperglycemia, which is associated with increased morbidity and mortality in various cancer populations. Using a retrospective design, we examined incident hyperglycemia in PN and non-PN recipients and the associations with clinical events and 5-year survival in a cohort treated for myeloma with melphalan and auto-SCT (n=112). Clinical comparisons were made at admission, and “before” and “after” initiating PN to discern differences and temporality. Actual infusion times were used for PN patients; timeframes based on mean PN infusion days were created for the non-PN recipients. Oral intake was lower “before” in PN vs. non-PN patients (p=<0.001); however, no differences in mucositis, emesis, infections or transfusions were detected “before.” Incident hyperglycemia (≥7.0 mmol/L) was significant “after” PN initiation, and PN recipients experienced delays in WBC (p<0.05) and platelet engraftment (p= 0.009) and required significantly greater RBC (p=0.0014) and platelet (p=0.001) support “after” than non-PN patients. Neutropenic fever and longer hospital stay were more frequent among PN vs. non-PN recipients (p<0.001). Differences in 5-year mortality were not apparent. Findings fail to support clinical benefits of PN administration during auto-SCT for myeloma. Further study is needed to discern if hyperglycemia or feeding per se was deleterious in this patient population.

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Section: Introductionmentioning

confidence: 99%

Incident hyperglycemia, parenteral nutrition administration and adverse outcomes in patients with myeloma admitted for initial auto-SCT

Sheean

Kilkus

Liu

et al. 2013

Bone Marrow Transplant

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“…63 On the other hand, pediatric patients younger than 2 or 3 years old are prone to developing hypoglycemia with abrupt discontinuation of PN and therefore require more gradual taper-down procedures in conjunction with cycling. 59,60 During the transition to a cycled PN regimen, on-cycle and off-cycle glucose monitoring should take place daily. Once patient tolerance to cycled PN is established, less frequent glucose monitoring may be acceptable, especially in stable home PN patients.…”

Section: Medical Devices and Equipmentmentioning

confidence: 99%

A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations

Ayers

Adams

Boullata

et al. 2013

J Parenter Enteral Nutr

200

230

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Parenteral nutrition (PN) serves as an important therapeutic modality that is used in adults, children, and infants for a variety of indications. The appropriate use of this complex therapy aims to maximize clinical benefit while minimizing the potential risks for adverse events. Complications can occur as a result of the therapy and as the result of the PN process. These consensus recommendations are based on practices that are generally accepted to minimize errors with PN therapy, categorized in the areas of PN prescribing, order review and verification, compounding, and administration. These recommendations should be used in conjunction with other A.S.P.E.N. publications, and researchers should consider studying the questions brought forth in this document.

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“…However, a schedule in which the PN is cycled to infuse over 10 to 14 hours (based on patient tolerance) can offer physiologic and psychological benefits to patients in selected circumstances. 59,60 The conversion from a continuous to a cycled administration period typically takes place by reducing the infusion time by 4 to 6 hours each day until the infusion time has been compressed to the target duration. However, one recent study suggests that cycling PN to 12 hours can be accomplished in one step.…”

mentioning

confidence: 99%

“…63 On the other hand, pediatric patients younger than 2 or 3 years old are prone to developing hypoglycemia with abrupt discontinuation of PN and therefore require more gradual taper-down procedures in conjunction with cycling. 59,60 During the transition to a cycled PN regimen, oncycle and off-cycle glucose monitoring should take place daily. Once patient tolerance to cycled PN is established, less frequent glucose monitoring may be acceptable, especially in stable home PN patients.…”

mentioning

confidence: 99%

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A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations

et al. 2014

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! Abstract !Parenteral nutrition (PN) serves as an important therapeutic modality that is used in adults, children, and infants for a variety of indications. The appropriate use of this complex therapy aims to maximize clinical benefit while minimizing the potential risks for adverse events. Complications can occur as a result of the therapy and as the result of the PN process. These consensus recommendations are based on practices that are generally accepted to minimize errors with PN therapy, categorized in the areas of PN prescribing, order review and verification, compounding, and administration. These recommendations should be used in conjunction with other A.S.P.E.N. publications, and researchers should consider studying the questions brought forth in this document.

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Type and Prevalence of Adverse Events During the Parenteral Nutrition Cycling Process in Patients Being Prepared for Discharge

Abstract: Most patients incur AEs during PN cycling, primarily mild hyperglycemia and tachycardia. These findings suggest patients need to be monitored closely and treated aggressively for complications during PN cycling.

Cited by 15 publications

References 9 publications

Incident hyperglycemia, parenteral nutrition administration and adverse outcomes in patients with myeloma admitted for initial auto-SCT

Incident hyperglycemia, parenteral nutrition administration and adverse outcomes in patients with myeloma admitted for initial auto-SCT

A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations

A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations

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