Spanish consensus on the preparation of parenteral nutrient mixtures - General aspects.

Translated article] Spanish consensus on the preparation of parenteral nutrient mixtures - General aspects.

Parenteral nutrition (PN) is a complex therapeutic intervention, particularly in pediatric and critically ill patients, requiring strict standards of safety, stability, and compatibility during its preparation. To update and harmonize clinical practice, the Pharmacy Working Group of the Spanish Society of Clinical Nutrition and Metabolism (SENPE) and the Spanish Society of Hospital Pharmacy (SEFH) have developed a new multidisciplinary consensus. This document addresses key practical questions and provides recommendations grounded in scientific evidence and clinical experience. The consensus focuses on six key areas related to PN preparation: lipid emulsion stability and lipid peroxidation; calcium-phosphate precipitation risk; stability of amino acids, vitamins, and trace elements; quality control and labeling; automated compounding systems and multi-chamber bags; and drug-PN compatibility. It outlines strategies to minimize physicochemical instability, including guidelines on analytical techniques, the recommended sequence of component addition, and preventive measures to avoid destabilization phenomena. This document serves as a practical guide for healthcare professionals involved in the compounding and administration of PN across various clinical settings. Recommendations were developed using a structured consensus methodology (adapted Delphi technique) and were unanimously endorsed by all participating experts. The result is a reference tool that supports safety, quality, and efficiency in PN preparation throughout Spain.

Comparing the risk of bloodstream infections by type of parenteral nutrition preparation method: A large retrospective, observational study

Standards for Specialized Nutrition Support: Home Care Patients

Clinical relevance of parenteral nutrition prescription and administration in 200 hospitalized patients: A quality control study

Background: the administration of aluminum-contaminated parenteral nutrition (PN) leads to an accumulation of aluminum. The aim of this study was to assess blood aluminum concentrations (BACs) of inpatients receiving multichamber-bag (MCB) PN compared to those receiving compounded PN. Methods: available BACs were retrospectively gathered from patient charts of adult inpatients receiving PN from 2015 to 2020, and compared depending on the type of PN administered. Long-term PN patients, defined as ≥ 20 days of PN, receiving at least > 10 days of compounded PN, were compared to long-term patients receiving only MCB. Results: a total of 160 BACs were available from 110 patients. No differences were found according to type of PN (mean BAC: 3.11 ± 2.75 for MCB versus 3.58 ± 2.08 µg/L for compounded PN). Baseline total bilirubin, surgery and days with PN were related to higher BACs (coefficient: 0.30 [95 % CI, 0.18-0.42], 1.29 [95 % CI, 0.52-2.07], and 0.06 [95 % CI: 0.01-0.11], respectively). Regarding long-term PN, patients receiving only MCB (n = 21) showed lower BACs compared to the compounded PN (n = 17) [2.99 ± 1.55 versus 4.35 ± 2.17 µg/L, respectively; p < 0.05]. Conclusions: although there were no differences in BAC according to type of PN administered, in long-term PN, MCB PN was associated with lower BACs as compared to compounded PN.

A prospective randomized study of total parenteral nutrition for long spinal deformity fusions as well as its effect on complications and recovery from postoperative malnutrition was performed. To determine whether the administration of total parenteral nutrition to patients undergoing same-day or staged long spinal fusions has an effect on postoperative nutritional parameter depletion, time for return to preoperative nutritional baseline, and complication rate. Several studies have suggested, but only one has demonstrated, that perioperative administration of total parenteral nutrition to patients undergoing spinal reconstructive surgery may reduce postoperative nutritional depletion, thereby decreasing postoperative complications. In this study, 46 patients undergoing same-day or staged spinal reconstruction surgery (> or = 10 levels) were randomized to receive or not receive total parenteral nutrition after surgery. The nutritional parameters of albumin, prealbumin, transferrin, total protein, and absolute lymphocyte count were obtained before surgery and at regular intervals after surgery until at least four out of five parameters were within 10% of their preoperative baseline value. Perioperative data and complications were tallied. There were no complications related to total parenteral nutrition administration. There was no statistical difference in total complications between those who did and those who did not receive total parenteral nutrition. However, there was a trend (P < 0.073) for the total parenteral nutrition group to return to nutritional baseline quicker. A significant increase in transferrin (P < 0.0082) and prealbumin (P < 0.015) depletion occurred in the patients who did not receive total parenteral nutrition. The anterior/posterior-same-day patients receiving total parenteral nutrition had more major complications (P < 0.033) and significantly more total protein depletion (P < 0.018) than the anterior/posterior-staged patients receiving total parenteral nutrition, possibly because the anterior/posterior-staged group received significantly more days(P < 0.0155) of total parenteral nutrition than the anterior/posterior-same-day group. In controlling for the number of days of total parenteral nutrition, no significant difference between type of surgery and complications was found. The administration of postoperative total parenteral nutrition to patients with spinal deformity is safe. No statistical reduction in complications occurred in the total parenteral nutrition group despite a trend toward more rapid normalization of nutritional parameters and a decrease in postoperative nutritional depletion. The anterior/posterior-staged group with the administration of total parenteral nutrition had a lower overall complication rate and a decreased incidence of postoperative nutritional depletion than the one-stage reconstruction group. The difference in the complication rates between the two groups may relate as much to the staging as to the administration of total parenteral nutrition per se. For certain cases it may be more advisable to stage patients and deliver total parenteral nutrition than to manage the cases in a continuous (i.e., same-day) fashion.

Background and ImportancePaediatric patients receiving parenteral nutrition (PN) are particularly vulnerable to aluminum exposure, a known contaminant in PN formulations.Aim and ObjectivesThis study aimed to quantify the aluminum concentrations in...

Parenteral nutrition (PN) is associated with material and manpower costs and requires preparation time. The aim of this study was to evaluate the cost of PN using multichamber bags (MCBs) compared with hospital-compounded bags (COBs). The secondary aim of this study was to assess and compare preparation time and errors related to the production and preparation processes of PN bags. A prospective, observational, cost-accounting study was conducted in 10 Spanish hospital pharmacy services. The cost assessments included components, raw materials, and hospital staff. Only PN bags with equivalent volume and nutrition value were included in the analyses. Assessment of errors related to PN was performed simultaneously with the cost and time comparison analyses. Among the 597 PN bags (295 MCBs, 302 COBs) evaluated, 392 PN bags (295 MCBs, 97 COBs) had an equivalent volume and nutrition value. The mean (standard deviation) total cost of the MCB was $62.11 ($12.34) per bag compared with $67.54 ($8.50) per bag for COBs, resulting in a significant cost savings of $5.71. On average, the time required to prepare an MCB was 38 minutes shorter (P < .001). Significantly fewer total number (percent) of errors was observed in the preparation of MCBs (3 [1.0%]) compared with COBs (15 [5.0%]); P < .01). The use of MCBs results in significant savings in cost and preparation time, which may have a beneficial effect on the economic burden associated with PN as well as a reduction in errors related to PN preparation.

ESPEN Guidelines on Parenteral Nutrition: Geriatrics

AimWithout additions of micronutrients, Multi Chamber Bags (MCBs) of Parenteral Nutrition (PN) are referred to as ‘unsupplemented’. When containing a full range of micronutrients MCBs are referred to as ‘supplemented’.The...

AimNICE guidelines recommend that once a neonatal patient is eligible for parenteral nutrition (PN), it should be administered within 8 hours.1 Therefore, the aim for this audit is to assess...

Free radical formation in infants: The effect of critical illness, parenteral nutrition, and enteral feeding

Manganese in Parenteral Nutrition: Who, When, and Why Should We Supplement?

Introduction: We present the dual use of an arteriovenous fistula (AVF) for contemporaneous administration of home parenteral nutrition (PN), and hemodialysis (HD). Case Report: A 52 year old female patient required PN due to short bowel syndrome, following extensive resection for ischemic bowel. After she was rendered dialysis dependent secondary to multifactorial renal failure, a left forearm basilica vein transposition onto the radial artery was undertaken. Venous access for PN was problematic. We commenced home PN via the AVF, using a ‘buttonhole’ technique to cannulate the fistula for both HD and PN. The peripheral administration of PN necessitated reduction in the osmolality, with larger volumes and longer administration times. This required adjustment of the HD regime to compensate.The patient received simultaneous PN and HD at home through the AVF successfully for seven weeks. Unfortunately after this time she suffered a staphylococcal fistula infection with septicemia. Discussion: We have shown that dual use of AVF for HD and PN is feasible, although not without risk. Reduction of osmolality and staggering of PN and HD sessions is required, with administration of PN over longer times. It has been shown that the buttonhole cannulation technique has a higher rate of infection than alternatives, and we propose this may have contributed to our patient’s complication. We believe this report would be helpful if dual use of AVF for PN and HD is contemplated.