A descriptive analysis of individually compounded home parenteral nutrition prescriptions provided to adults with chronic intestinal failure

Abstract

Background & AimsHome Parenteral Nutrition (HPN) prescriptions should be tailored to a patient’s nutritional requirements and comprise of individually compounded regimens (IC-HPN) or standard licensed multi-chamber bags (MCB). There is a paucity of research exploring factors associated with admixture type. This study aimed to evaluate the nutrient composition of adult IC-HPN prescriptions and variance in nutrient dosing, make comparisons with the range of MCB available and dosing recommendations stated in international guidelines. MethodsThis cross-sectional observational study analysed anonymised prescription data for adults under the care of a single home care company in England, commencing IC-HPN after January 2021. ResultsThere were 155 patient prescriptions (245 HPN bags) included, with body weight available in 82 (52.9%) cases. Data were reported for each HPN bag, and summarised as an average daily amount, considering the number of different HPN bags and their daily frequency per patient prescription.A vast range of nutrients were prescribed, with variance in dosing highest for lipid, phosphate, and calcium; with coefficient of variance of 106%, 74% and 67%, respectively. One-hundred-thirty-four (54.7%) bags contained lipid, resulting in variable ratios of lipid to aqueous bags provided weekly.Negligible amounts of at least one electrolyte were prescribed in 93 (38.0%) bags, of which 52 (21.2%) contained < 2 mmol calcium. Compared with MCB (65 bags), IC-HPN bags contained higher amounts of all nutrients, apart from nitrogen and phosphate. Mean sodium intake differed substantially between types of bags (IC-HPN 187.5, SD 100.1 mmol versus MCB 49.1, SD 31.7 mmol, p<0.001). A substantial number of patients received HPN dosages beyond guideline recommendations, with higher amounts of sodium and fluid provided in 41 (50.0%) cases; conversely, lower than recommended dosages were seen in 55 (67.1%) for potassium and 61 (74.4%) for calcium. ConclusionsThis study has demonstrated vast variance in IC-HPN parenteral nutrient dosing, with minimal or an omission of at least one nutrient seen. Further research is needed to explore factors that influence usage of IC-HPN, clinical reasons related to lipid dosing and around the variation in doses prescribed outside of guideline recommendations.