Adéquation des apports en nutrition parentérale : poches à la carte ou prémélanges industriels ?

Abstract

Objective. – To assess the constraints to prescribe parenteral nutrition multi-compartment bags commercially available for patients who were previously treated by hospital-compounded bags. Methods. – We compared the nutrient intakes of 25 patients treated by hospital pharmacy compounded bags then by multi-compartment bags. Results. – The indications were: perioperative complications (52%), ischemic bowel disease (20%), cancer (12%), radiation enteritis (12%) and miscellaneous (4%). The frequency of infusion was 6 ± 1.8 days/week. Sixteen patients had an ostomy. Two of the 25 patients were on total parenteral nutrition. The average number of extra infusion bottles was 2.2 ± 1.2. 0.7 ± 0.7 of the bottles were shunt connected with the industrial multi-compartment bag. We found intake differentials between hospital-compounded bags and industrial multi-compartment bags. They were small for the carbohydrates (mean ± standard deviation: 40 ± 126 kcal), the lipids (–25 ± 115 kcal) and, after supplementation, for the sodium (–12.7 ± 52 mmol), the potassium (1.4 ± 14.8 mmol) and the volume (–16 ± 362 ml). Despite mean supplementation of –3.1 ± 3.6 mmol for calcium and –2.6 ± 4.6 mmol for magnesium, amounts were always lower than in pharmacy compounded bags. Nitrogen (2.2 ± 2.7 g) and phosphorus amounts (3.6 ± 9.8 mmol) provided by multi-compartment were in excess. Conclusion. – The prescription of commercially available multi-compartment bags requires many supplementation and piggy bag method in order to have a formula similar to those of hospital pharmacy compounded bags.