Abstract
In the last two decades, there has been a significant degree of controversy surrounding the use of standardized parenteral solutions. Opponents of standardized parenteral nutrition claim that individualized parenteral nutrition is necessary because the critically ill patient requires daily manipulation of macro- and micro-nutrients secondary to stress associated with complex ailments. The purpose of this study was to determine if premixed parenteral nutrition solutions were equally safe and efficacious, while being less costly, in managing parenteral nutrition of patients at a large metropolitan teaching hospital, as compared to customized parenteral nutrition solutions. This was a randomized controlled trial with no placebo involving 100 patients requiring central parenteral nutrition. Consenting patients received either customized parenteral nutrition or premixed double chamber parenteral nutrition containing protein, carbohydrates and electrolytes. Vitamins and trace elements were added as needed. Each subject enrolled in the study was followed until the parenteral nutrition was either discontinued, the patient was transferred from the facility, or the patient expired during the study. Premixed and customized parenteral nutrition solutions were shown to be equally efficacious in patients as their blood glucose, fluid status, nutritional markers, serum electrolytes, phosphate, and magnesium values were within normal limits (p<.05). Premixed parenteral nutrition is associated with significantly better safety as compared to customized parenteral nutrition (11). Furthermore, the cost difference was $41,934 when comparing the premixed formulation to the customized solution. In this study, premixed parenteral nutrition solutions were equally safe, effective, and less costly than customized parenteral nutrition formulas. Patients receiving premixed parenteral nutrition experienced less adverse drug reactions and metabolic abnormalities than patients receiving customized parenteral nutrition.
Highlights
Parenteral nutrition (PN) solutions are utilized to ensure an adequate delivery of calories and protein when patients are unable to take sufficient food by either the oral route or via feeding tube
Current literature supports the usefulness of premixed parenteral nutrition in the management of nutritional intake in patients who require parenteral nutrition
A non-randomized study published in P & T suggests there may be improved electrolyte management in patients receiving standardized PN
Summary
Parenteral nutrition (PN) solutions are utilized to ensure an adequate delivery of calories and protein when patients are unable to take sufficient food by either the oral route or via feeding tube. In 2003, the Joint Commission developed stipulations that drug concentrations be standardized and limited in number as part of the Joint Commission National Patient Safety Goals of 2003.[1] In response to this mandate, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) reviewed the published literature for the use of a standardized PN formulation to recommend to hospitals as a commercially prepared, premixed formulation.[2] A.S.P.E.N. recognized the need that hospitals continue to have the ability to use customized, compounded PN formulations, after ensuring that the compounding process becomes standardized and adheres to national recommendations. No recommendation was made on whether hospitals should preferentially use commercially, premixed formulations or compounded PN formulations.[2]
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