Adequacy of three-compartment parenteral nutrition bags to current European guidelines for adults: a simulation study.

Adequacy of three-compartment parenteral nutrition bags to current European guidelines for adults: a simulation study.

BackgroundIt is widely recommended that stock parenteral nutrition (PN) bags are used where possible to reduce the risks associated with bespoke PN compounding.1 A review was undertaken within a level three neonatal unit which identified that a large proportion of compounded bags were made due to the need to provide full nutrition in a smaller volume. A preterm concentrated aqueous PN bag was developed which, when run with stock lipid syringes, meets the nutritional requirements of preterm babies in a total volume of 100 ml/kg/day.2AimThe aim of this work is to evaluate the impact of the introduction of a preterm concentrated stock bag on the need for bespoke PN in preterm babies.MethodThe new concentrated PN bag was transitioned into use from November 2017. Data regarding the number of preterm patients admitted and the type of PN they received was collected from January to October 2017, (Group A), this was then repeated for all preterm patients admitted from August 2018 to May 19, (Group B), after the preterm concentrated bag was fully introduced. Preterm babies were classified as babies that were born < 34 weeks gestation as the concentrated bag was formulated with these patients in mind.ResultsGroup A, (n=143), had 1045 bags supplied over the collection period. 47% of the PN bags supplied were bespoke PN bags, largely due to the need to provide PN in a smaller volume than the 130 ml/kg/day that the preterm stock bags available at that time. Group B, (n=118), had a total of 965 bags supplied, 16% of these bags were bespoke PN. The reasons behind requiring bespoke bags included the need for manganese free bags, requiring a reduction in glucose and a high electrolyte requirement in patients especially those with stomas. This has resulted in an overall reduction in spend on preterm PN of 34% and a reduction in compounded PN spend of 69%.ConclusionThis work has highlighted several benefits of introducing preterm concentrated PN bags. Firstly having concentrated preterm stock bags available on the ward has meant that a larger proportion of babies are maintained on stock PN without recourse to compounded PN. Secondly this has preserved the compounding capacity of our technical services unit so when a patient requires a bespoke bag that facility is available. Also, capacity for the compounding service has been preserved across the hospital minimising the need to outsource compounding. Finally the neonatal unit has seen a reduction in overall PN costs in this patient group. The introduction of this bag has been instrumental in reducing the need to outsource PN bags to commercial compounding units during periods of high demand, meeting national recommendations on the management of aseptic compounding capacity.3ReferencesA Report from the Paediatric Chief Pharmacists Group: Improving Practice and Reducing Risk in the Provision of Parenteral Nutrition for Neonates and Children. November 2011.British Association of Perinatal Medicine. The Provision of Parenteral Nutrition within Neonatal Services - A Framework for Practice. April 2016.Specialist Pharmacy Service/NHS England. National Pharmaceutical Supply Group (NPSG) Communication: Making best use of restricted aseptic compounding capacity. September 2018.

Standards for Specialized Nutrition Support: Home Care Patients

Costs of being extreme — Do body size deviations from population or sire means decrease vitality in rainbow trout?

Introduction HPN support should be a nutritional management strategy in patients who cannot meet their nutritional requirements by oral or enteral routes and those who are eligible to receive therapy outside an acute-care setting. 1 However, use of HPN in incurable patients who cannot eat remains controversial and is only accounted for by approximately 8% of the UK HPN population. 2 We therefore aimed to describe the HPN palliativeoncology cohort at University College London Hospital (UCLH) and identify what factors determine their survival rates and performance status. Method Data was collected retrospectively and prospectively for palliative oncologypatients receiving HPNthrough hospital computer systems and databases stored by members of the Nutrition team at UCLH between 01/01/2006 to 31/12/2014 (censor date). Survival time was expressed in weeks, Kaplan Meier curves were plotted and performance status was obtained using Karnofsky score (KPS). Results A cohort of n = 65 (n = 12 active at analysis) palliative oncology patients (male 36.9%, median age 56 years) recieved HPN at UCLH from 2006–2014. Cancers of the following aetiologies comprised most of the cohort: upper gastrointestinal (n = 13, 20%); lower gastrointestinal (n = 15, 23%); and gynaecological (n = 24, 36.9%). The main indicator for HPN was bowel obstruction (n = 44). Overall mean/median survival was 22.4 and 10 weeks (range: 0.4 to 193.3), respectively (Figure 1). Survival also differed by malignancy (mean/median survival-weeks: upper gastrointestinal 10.3/6.4; lower gastrointestinal 24.8/10.7), gynaecological 28.1/8.3). Overall median KPS was 50. The correlation between KPS and survival from discharge to death was r = 0.315 (P Abstract PTH-208 Figure 1 Survival of palliative oncology HPN patients (N = 65) Conclusion Our results show there is an indication for HPN in palliative oncology patients as it may increase survival period post hospital discharge however this may differ by underlying malignancy. In addition, HPN may improve performance status. Further research is required into patients’ quality of life to provide holistic as well as medical insights into HPN in this patient group. Disclosure of interest None Declared. References Staun M, et al . ESPEN guidelines on Parenteral nutrition: Home Parenteral Nutrtiion (HPN) in adult patients. Clin Nutr. 2009:467–479 BANS: Annual BANS Report, 2011; Artificial Nutrition Support in the UK 2000–2010. www.bapen.org.uk

Background Patients undergoing invasive diagnostic coronary angiography (DCA) for the first time often display high levels of anxiety at the time of their procedure as they are unfamiliar with the cardiac catheter laboratory set up. It is therefore part of the cardiac catheter laboratory staff′s role to reduce patient fears and hence improve their journey through the cardiac catheter laboratory. Several Cardiac centres have recently introduced radial lounges whereby patients feel less “hospitalised” by not needing to undress for their procedure. Methods Following infection control approval, between mid-August 2010 and the end of October 2010, patients undergoing radial DCA at Salisbury District Hospital were offered the option of remaining clothed for their procedure. Each patient was given an information leaflet included in which was explained possible downsides to being dressed including if CPR were needed then clothes would be cut, failure of radial access and the subsequent need for femoral access, and the possibility of soiling the clothes with either blood or iodine. The only caveat stated was that female patients were not allowed to wear an underwire bra. Following their DCA, patients were then asked to fill in an anonymous questionnaire in which they were asked about their experience and whether not having to undress made them feel more relaxed. Results 57 consecutive patients underwent (DCA) during this time period (100% uptake) with an average age of 68.1 ± 9.6 years. 71% were male and 21% (12/57) had undergone a DCA previously. Of these 12 patients 92% (11/12) stated that not having to undress was a good idea while an identical number felt much more relaxed than their previous DCA experience. Of the 45 patients that had not had a previous DCA, 96% (43/45) stated that not having to undress was a good idea while 96% (43/45) felt that this had made them feel very relaxed during their pathway. The other two patients felt that it made no difference. No patients required cross-over to femoral access and there were no blood or iodine stains on any clothes. Having patients remain dressed did not reduce fluoroscopic image quality and there were no issues with infection. Conclusion Offering patients the option of having their radial DCA done without undressing is safe and helps to improve the patient journey through the cardiac catheter laboratory by making them feel more relaxed and less hospitalised. This is now standard at our Institution.

BackgroundCritically ill patients are characterised by hypercatabolism, representing a higher risk of malnourishment. In these patients, both nutrient deficits and overfeeding are harmful. Parenteral nutrition (PN) is an alternative approach...

ESPEN Guidelines on Parenteral Nutrition: Intensive care

ABSTRACTAimTo gain an understanding of palliative care need and provision in adult medical and surgical inpatients.DesignAn observational point prevalence study was conducted across four study sites in Western Australia.MethodsAll data were collected directly from patient medical records by Registered Nurses. Potential palliative care need was assessed using disease‐specific indicators for the 12 conditions outlined in the Gold Standards Framework Proactive Indicator Guidance.ResultsA total of 865 medical and surgical inpatients met study inclusion criteria. Across the four study sites, 38% (n = 331) of adult inpatients reviewed could have potentially benefitted from palliative care. Of the n = 331 patients assessed as having indicators for palliative care, there was evidence that 27% (n = 90) were currently receiving some form of palliative care, while 3% (n = 9) had been referred for specialist palliative care. For the majority of patients (70%, n = 232) there was no evidence of them receiving any form of palliative care or awaiting specialist palliative care.ConclusionThis study identified high levels of potential palliative care need among adult medical and surgical inpatients. The majority of the patients identified as having indicators for palliative care were not receiving any form of palliative care.Implications for the Profession and/or Patient CareThe high prevalence of palliative care need found in this study highlights that recognising and addressing palliative care is essential for high‐quality care for medical and surgical inpatients. To address the high level of need identified all nurses require basic palliative care training to provide optimal patient care.ImpactKnowledge about the level of palliative care need and provision of palliative care in public hospitals was limited. This study identified a high prevalence of potential palliative care need in medical and surgical inpatients. The majority of patients with indicators for palliative care were not receiving any form of palliative care. This research demonstrates that palliative care needs should be considered by all registered nurses and other health professionals caring for medical and surgical inpatients.Reporting MethodThe study is reported using the STROBE guidelines.Patient or Public ContributionNo patient or public contribution.

Quality control of parenteral nutrition in hospitalized patients

The pharmacokinetics of unbound platinum after administration of an anticancer drug nedaplatin, cis-diammineglycolateplatinum were examined using population analysis. The relevant covariates and the extent of inter- and intra-individual variability were evaluated. In order to clarify the pharmacokinetic profile of nedaplatin, unbound platinum concentrations (789 points) in plasma after intravenous infusion of nedaplatin were obtained from 183 courses for 141 patients. Plasma concentration data were analysed by nonlinear mixed effect modelling using NONMEM to evaluate the population mean parameters and variances for inter- and intra-individual random effects. The final population model was validated by parameter sensitivity analysis using objective function mapping, the bootstrap resampling and a data-splitting technique, i.e. the Jackknife method, and the predictive performance of the final model was evaluated. A two-compartment pharmacokinetic model with zero-order input and first order elimination described the current data well. The significant covariates were creatinine clearance (CLcr) for clearance of platinum (CL) [population mean [95% confidence interval (CI)] CL (l h(-1)) = 4.47 (3.27, 5.67) + 0.0738 (0.0581, 0.0896) x CLcr (CLcr: ml min(-1))] and body weight (BW: kg) for volume of distribution of platinum (Vc) [Vc (l) = 12.0 (7.5, 16.5) + 0.163 (0.081, 0.246) x BW]. Inter-individual variations (CV%, 95% CI) for CL and Vc were 25.5% (20.7, 29.6) and 21.4% (17.0, 24.1), respectively, and intra-individual variation (CV%, 95% CI) was 12.6% (10.5, 14.4). The effects of pretreatment with nedaplatin or other platinum agents on clearance and volume of distribution were also tested, but no significant effect was found. The relationship between the observed and predicted unbound platinum concentration by empirical Bayesian prediction showed good correlation with no bias, suggesting that the final model explains well the observed data in the patients. The mean prediction error and root mean square prediction error (95% CI) were - 0.0164 micro g ml(-1) (- 0.4379, 0.4051) and 0.2155 micro g ml(-1) (not calculable, 0.6523), respectively. The values of mean, standard error and 95% CI for objective function mapping, the bootstrap resampling, the Jackknife estimates and the final model coincided well. A population pharmacokinetic model was developed for unbound platinum after intravenous infusion of nedaplatin. Only creatinine clearance was found to be a significant covariate of clearance, and BW was found to be a significant covariate of volume of distribution. These population pharmacokinetic estimates are useful for setting initial dosing of nedaplatin using its population mean and can also be used for setting appropriate dosage regimens using empirical Bayesian forecasting.

LB002-MON A SURVEY ON ARTIFICIAL NUTRITION PRACTICES IN A FRENCH TEACHING HOSPITAL

Etiology and Initial Management of Short Bowel Syndrome

Building on its best-selling predecessors, Basic Statistics and Pharmaceutical Statistical Applications, Third Edition covers statistical topics most relevant to those in the pharmaceutical industry and pharmacy practice. It focuses on the fundamentals required to understand descriptive and inferential statistics for problem solving. Incorporating

IntroductionPrognostic factors in patients on home parenteral nutrition (HPN) are primarily thought to be related to the underlying disease. 1 To the best of our knowledge, there is no data...