Parenteral Nutrition Bags Research Articles

Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Background: The best insulin regimen to treat hyperglycemia in hospitalized patients on nutritional support (NS) is unclear. Methods: We searched electronic databases to identify cohort studies or randomized clinical trials in order to evaluate the efficacy of different insulin regimens used to treat hyperglycemia in hospitalized patients on NS on diverse outcomes: mean blood glucose (MBG), hypoglycemia, length of stay in hospital, and mortality. Results: Seventeen studies from a total of 5,030 were included. Enteral Group included 8 studies; 1,203 patients using rapid, glargine, NPH, or Premix insulin; MBG 108-225 mg/dL; hypoglycemia 0-13%. In indirect meta-analyses, NPH insulin ranked best for glucose control (MD 95% CI -2.50 mg/dL [2.65 to -2.35]). Parenteral Group included 4 studies; 228 patients using regular and glargine or NPH insulin; MBG 137-202 mg/dL; hypoglycemia 0-40%. In meta-analyses comparing regular insulin added to parenteral nutrition bag with glargine, MBG (MD 95% CI -3.78 mg/dL [-11.93 to 4.37]; I² = 0%) or hypoglycemia frequency (RR 95% CI 1.37 [0.43-4.32]; I² = 70.7%) did not differ. The description related to hospital length of stay and mortality was inconsistent between groups. Conclusions: The best insulin regimen to treat hyperglycemia in hospitalized patients on NS has not been established; best results using insulin regimens with NPH in enteral nutrition do not seem to be clinically relevant.

Implantación de un sistema mSalud para la gestión y trazabilidad de la nutrición parenteral domiciliaria

Objetivo: Implantar un sistema mSalud para la gestión y trazabilidad de la nutrición parenteral (NP) domiciliaria.Método: Estudio descriptivo transversal, siendo la unidad de análisis las bolsas de NP de administración domiciliaria del Hospital Universitario Son Espases de Palma (HUSE), España, durante 3 meses. Las bolsas fueron etiquetadas con un identificador unívoco (etiqueta QR) que facilitó su lectura de datos mediante un dispositivo móvil. Las etapas a controlar fueron: validación y transcripción de la prescripción, preparación, conservación y administración, siendo los puntos críticos de control el control gravimétrico, la temperatura de conservación, el volumen y tiempo de infusión (bomba de administración) y la existencia e integridad del filtro (administración). La geolocalización se realizó a través del GPS del dispositivo y la visualización mediante un Mash-up de Google Maps.Resultados: En el proceso intervinieron 2 farmacéuticas y 20 enfermeros/as y se gestionaron 90 bolsas de NP. Las operaciones de control demostraron el cumplimiento del 100% de las etapas y del posicionamiento estático de la administración de la NP (con fecha y hora). Los resultados medios de los puntos críticos fueron: gravimetría 2217,76 ± 13,70 g, temperatura de las cámaras 4,20 ± 0,33 y 4,03 ± 0,34, volumen a administrar 1949,81 ± 7,52 ml y tiempo de infusión 15,22 ± 0,20 h.Conclusiones: Se ha conseguido implantar y verificar con éxito, en el HUSE de Palma (España), un sistema para la gestión y trazabilidad de la NP en la asistencia domiciliaria a un bajo coste y cuantificando los principales puntos de control.

Nitrogenous content in parenteral nutrition: a four-year experience in a general hospital. Critically-ill patient specificity

There have been several studies focusing on caloric intake during the last years, while protein content relevance has been underestimated. Some recent evidence has shown that protein deficiency has also an impact on patient outcomes. We have studied the nitrogen (N) content in parenteral nutrition (PN) bags administered to adult patients in a Spanish tertiary level hospital for four years. Patients who received parenteral nutrition in the general ward and Intensive Care Unit (ICU) were recorded. Caloric and protein content were registered and adjusted to weight and length of stay. Data were compared among three group of patients: those in the general ward, those in the ICU and those requiring renal replacement therapy (RRT). The one-factor analysis of variance (ANOVA) test was used after checking data normality and homoscedasticity. There was an increase in the mean g N/stay year after year (p < 0.01) from 14 to 15.5 g, with a decrease in non-protein caloric content (p < 0.001) from 111.6 to 101.8 kcal/g N. The range was established from 4.1 to 32.6 g. PN diets with ≥ 18 g N% ranged from 12.8% (2010) to 19.6% (2013). There were significant differences among the groups when comparing the variable g N/stay (p < 0.0001): 13.5 general ward vs15.9 ICU patients vs17.6 ICU with RRT, also when referring to adjusted weight. According to most recent recommendations nitrogen has been provided in higher amounts than previously, especially in critical care patients with RRT.

Cost analysis of home parenteral nutrition in Spain

Introduction: Home parenteral nutrition (HPN) improves quality of life, allowing patients to receive nutrition at home and providing a social and labor integration to these patients. Objective: To assess the direct costs of HPN in adult population in Spain. Methods: A literature review of the records of HPN in Spain, carry out by NADYA-SENPE Group (years 2007-2014), was performed. The analysis included the evolution of: patients requiring HPN, number of episodes/patient, mean duration of episodes, description of delivery routes and complications rate. HPN consumption and cost were estimated. Patients were grouped according to their pathological group: benign and malignant. Direct costs (€, 2015) included were: parenteral nutrition bags, delivery sets and costs due to complications. Results: The number of patients who receive HPN has increased over years (2007: 133 patients; 2014: 220 patients). The average number of episodes per patient ranged from 1-2 episodes per year. The average duration of those episodes decreased (2007: 323 days; 2014: 202.8 days). Tunneled catheters were the most used and septic complications were the most common. The average annual cost per patient was estimated at € 8,393.30 and € 9,261.60 for benign and malign disease respectively. Considering that 220 patients required HPN in 2014, an annual cost of € 1,846.524.96 (€ 1,389,910.55 directly due to HPN) and € 2,037,551.90 (€ 1,580,937.50 directly due to HPN) was estimated for patients with benign and malignant pathologies respectively. Conclusions: These results can be used to develop future economic evaluations on HPN and to establish effi cient prioritization strategies to allocate available resources.

Prescription of Paediatric Industrial Triple-Chamber Parenteral Nutrition Bags: When, Why, How?

Eine parenterale Ernahrung (PE) ist indiziert bei Darmversagen, wenn die Nahrstoffbedurfnisse mit oraler oder enteraler Ernahrung nicht gedeckt werden konnen. Der Nahrstoffbedarf von Kindern unterscheidet sich nicht nur von demjenigen Erwachsener, er variiert auch mit dem Alter. Einige nicht essenzielle Aminosauren sind fur die Jungsten essenziell und die notwendige Menge jedes Nahrstoffs, selbst wenn auf das Korpergewicht bezogen, ist altersabhangig. Daraus ergibt sich, dass Mischungen zur PE auf den Bedarf von Kindern zugeschnitten sein mussen, um den Bedarf der Patienten zu decken. Parenterale Ernahrung, die individualisiert zusammengestellt und compoundet wird, bedarf der Expertise des Verschreibers und die Herstellung muss hohen Herstellungsstandards gemas Good Compounding Practices genugen. Im Gegensatz hierzu bieten industriell hergestellte Dreikammerbeutel eine anhaltend verfugbare, sichere und leicht anzuwendende Alternative, die die Nahrstoffbedurfnisse eines breiten Patientenspektrums abdeckt, solange deren Bedurfnisse nicht zu weit vom jeweiligen Altersstandard abweichen. Ein industriell hergestelltes, hitzesterilisiertes, standardisiertes Dreikammerbeutelportfolio (Numeta®, Baxter), das speziell fur die Padiatrie entwickelt wurde, ist nun in Europa verfugbar. Es umfasst 3 Formulierungen, die entsprechend den ESPGHAN/ASPEN-Leitlinien entwickelt wurden und an die Nahrstoffbedurfnisse von Fruhgeborenen sowie Kindern und Heranwachsenden von 0 – 18 Jahren adaptiert sind. Die Numetaprodukte bieten relative Flexibilitat im Gebrauch (Nahrstoffzusatze sind moglich, die Fettgabe ist optional). Mikronahrstoffe mussen zugesetzt werden, da Dreikammerbeutel aus Stabilitatsgrunden keine Vitamine und Spurenelemente enthalten. Altersbezogene Nahrstoffempfehlungen wissenschaftlicher Gesellschaften sind die Grundlage fur die Einleitung der PE, die dann nach Wirksamkeit und Vertraglichkeit angepasst wird. Dieser Artikel widmet sich daruber hinaus den Vorteilen und den praktischen Aspekten der Verordnung von Ready-touse-Losungen zur parenteralen Ernahrung.

CAN THE '4 P'S OF PN' IMPROVE NEONATAL NUTRIENT INTAKE?

AimsELBW infants on NICU were found to have poor growth compared to network data. Previous audit work1 showed that the time from birth to PN did not meet unit guideline...

The Use of Parenteral Nutrition Support in an Acute Care Hospital and the Cost Implications of Short-term Parenteral Nutrition

Parenteral nutrition (PN) is indicated for patients who are unable to progress to oral or enteral nutrition. There are no local studies done on estimating the cost of PN in acute settings. The aims of this study are to describe the demographics, costs of PN and manpower required; and to determine the avoidable PN costs for patients and hospital on short-term PN. Patient data between October 2011 and December 2013 were reviewed. Data collected include demographics, length of stay (LOS), and the indication/duration of PN. PN administration cost was based on the cost of the PN bags, blood tests and miscellaneous items, adjusted to subsidy levels. Manpower costs were based on the average hourly rate. Costs for PN and manpower were approximately S$1.2 million for 2791 PN days. Thirty-six cases (18.8%) of 140 PN days were short-term and considered to be avoidable where patients progressed to oral/enteral diet within 5 days. These short-term cases totalled $59,154.42, where $42,183.15 was payable by the patients. The daily costs for PN is also significantly higher for patients on short-term PN (P <0.001). In our acute hospital, 90% of patients referred for PN were surgical patients. Majority of the cost comes from the direct daily cost of the bag and blood tests, while extensive manpower cost was borne by the hospital; 18.8% of our cohort had short-term avoidable PN. Daily PN may cost up to 60% more in patients receiving short-term PN. Clinicians should assess patient's suitability for oral/enteral feeding to limit the use of short-term PN.

PTU-108 Sustainibility of The Impact of Nutrition Support Team (NST) at a District General Hospital-5 Year Results: Abstract PTU-108 Table 1

Introduction Although in 2010 Croydon University Hospital had Parenteral Nutrition (PN) team,it was felt patient care could be improved by broadening the team’s scope and extending its influence. Audit showed that despite Trust policy on PN use, it was non-compliant with NCEPOD recommendations. This was a key driver to form a Nutrition Support Team (NST) in October 2010. Our aims were to reduce inappropriate use of PN and emergency PN, ensure administration through central venous catheters and encourage EN where appropriate. This analysis was to check for sustainability of impact of NST after 5 years. Methods In 2010 NST members included a Chemical Pathologist, Gastroenterologist, Dietitian and Pharmacist. In 2012, a Consultant Biochemist, Dietitian joined the team. Protocols were drawn up, ratified and made available on a NST link on Trust Intranet. Patients requiring PN had to be discussed with NST. Radiology Department was contacted for timely insertion of peripheral inserted central venous catheters (PICC). Medical and nursing staff were trained on care of lines and appropriate use of PN. Results Results are shown in the Table. Use of peripheral cannulae for PN has gone down from 31% in 2009/10 to 4% in 2010/11 to 0% since 2011/12.Cost savings have been made in a number of areas. In 2010/11, savings of £20,671 were made. In 2013,NST advised and implemented a change in supplier of PN bags, resulting in total cost savings of £19,822. The total number of referrals for PN, number of inappropriate referrals, use of emergency PN, number of patients requiring PN for Conclusion Our intervention resulted in safer,coordinated and appropriate delivery of PN which has been sustained over 5 years. The feedback from hospital management,clinical staff has been positive and encouraging. These results may be extrapolated to all hospitals that care for patients requiring parenteral nutrition. Disclosure of Interest None Declared

Staff accreditation in parenteral nutrition production in hospital pharmacy

This work aims to provide staff accreditation methodology to harmonize and secure practices for parenteral nutrition bags preparation. The methodology used in the present study is inspired from project management and quality approach. Existing training supports were used to produce accreditation procedure and evaluation supports. We first defined abilities levels, from level 1, corresponding to accredited learning agent to level 3, corresponding to expert accredited agent. Elements assessed for accreditation are: clothing assessment either by practices audit or by microbiologic test, test bags preparation and handling assessment, bag production to assess aseptic filling for both manual or automatized method, practices audit, number of days of production, and non-conformity following. At Angers Hospital, in 2014, production staff is composed of 12 agents. Staff accreditation reveals that 2 agents achieve level 3, 8 agents achieve level 2 and 2 agents are level 1. We noted that non-conformity decreased as accreditation took place from 81 in 2009 to 0 in 2014. To date, there is no incident due to parenteral bag produced by Angers hospital for neonatal resuscitation children. Such a consistent study is essential to insure a secured nutrition parenteral production. This also provides a satisfying quality care for patients.

Using Preliminary Risk Analysis (PRA) to Ensure Safety in the Preparation Process for Parenteral Nutrition Bags in Hospital Pharmacy

Abstract: The aim of this paper is to use the Preliminary Risk Analysis (PRA) method to assess the criticality of the different stages in the process of preparing parenteral nutrition bags for use in neonatal resuscitation and, if necessary, improve the handling of the process itself.: A functional analysis of the preparation process was carried out, and three main phases were identified: Phase 1 – Fielding the request; Phase 2 – Production; Phase 3 – Checks. Risks were mapped under 5 category headings (legal, environmental, physical, human and managerial). After the evaluation criteria had been identified, scenario descriptions were drawn up for each dangerous situation in order to ascertain the criticality level (C1–C3, C1 being the least critical) of the different risks and to seek out risk mitigation measures.: The PRA method identified 63 dangerous situations, 77.7 % of which had a very high level of vulnerability. The highest number of such situations was in the production phase. Seventy one scenarios were drawn up (19 for phase 1, 40 for phase 2 and 16 for phase 3, as the same scenario may occur in more than one phase). The study enabled a reduction in system criticalities: initially there were 6 C1 scenarios, 44 C2’s and 21 C3’s and following the study there were 45 C1’s, 26 C2’s and 0 C3 scenarios. The most significant initial risks were linked to environmental, managerial and human factors whilst the most significant residual risks were environmental or legal in nature.: PRA is a viable assessment method in the health sector and has enabled the establishment of new measures seeking to minimise risk levels in the preparation process of parenteral nutrition bags.

Travelling With Children on Home Parenteral Nutrition.

Home parenteral nutrition (HPN) is an established therapy in children with intestinal failure. Parenteral nutrition (PN) management allows most paediatric patients to participate in age-appropriate activities; however, HPN may lead to significant restrictions, particularly going on holiday. We aimed to identify sociodemographic and illness-specific variables that influence if and how families with children on HPN travel. A standardised questionnaire was sent to all 40 children on HPN within a large tertiary intestinal failure centre in the United Kingdom. Depending on whether the family had/had not been on holiday since their child had started HPN, questions were asked to understand the reasons for not travelling or to gather information about individual travel experiences. A total of 30 children were enrolled, 20 of 30 went at least once on holiday, and 5 of 30 travelled more than once per year, 70% travelled outside Britain. Going on vacation was more common, the longer the child had been on HPN (P = 0.022); hours spent on PN tolerance of enteral feeds or the child's age did not influence travel behaviour; 80% of parents who went on vacation had a good/worthy experience, 95% would travel again. The biggest reported obstacle was the transportation of PN bags. Ten families sacrificed a holiday over fear that it may be difficult to arrange or because of the child's unstable medical condition. A significant proportion of families chose to go on holiday away from home despite their child being on HPN. The experience is considered good by most.

Quantitative analysis of insulin in total parenteral nutrition bag in Taiwan

Regular insulin can reduce hyperglycemia when directly added to total parenteral nutrition (TPN) solutions. Insulin is not routinely added to all TPN solutions. For patients who require insulin prior to the initiation of TPN supplement, one-third to one-half of the usual total daily dose can be added to the TPN bag as regular human insulin. However, an incorrect dose or an interaction between insulin and the TPN bag material may affect blood sugar control in clinical practice. Therefore, it is important to quantitatively determine the final dose of insulin in the TPN bag. High performance liquid chromatography is a very powerful technique for determining the purity of proteins. The goal of this study was to use high-performance liquid chromatography to perform quantitative analysis of insulin in a TPN bag. The analysis was performed under different light conditions (UV, fluorescent, and darkness) and different temperatures (25°C and 2–8°C). The results show that adsorption of insulin on an ethylene vinyl acetate TPN bag is significantly higher than that on glass. Based on the results, it is evident that regular insulin should be administered separately from TPN to reduce cost and eliminate wasteful disposal of TPN solutions.

PTH-214 An audit reviewing the impact of a nutrition multi-disciplinary team on wastage of adult parenteral nutrition bags

Introduction At our hospital prior to April 2014, patients commenced on parenteral nutrition (PN) were reviewed on a daily basis by the chemical pathology registrar and once weekly on a multi-disciplinary nutrition team (MDT) ward round. PN was prescribed and manufactured in advance where possible to help facilitate the work flow within the pharmacy aseptic unit. In April the nutrition MDT recruited a nutrition clinical nurse specialist (CNS) and introduced twice weekly consultant led MDT ward rounds. In addition, daily reviews of all PN patients are done by the CNS and a pharmacist with the registrar, for daily prescriptions. The aim of this audit was to assess the impact of the enhanced nutrition support MDT on: (1) the percentage of PN bags used for the intended patients, (2) the projected annual financial cost of wasted PN, (3) the percentage of PN bags that have been reallocated where cold chain storage is assured, (4) the cost saving incurred as a result of reallocating wasted PN bags. Method Prospective data was collected on adult PN bags over a three month period between October – December 2014. All PN bags ordered from an external provider and standard PN bags from the aseptic pharmacy department were included. Any PN bags from other hospitals and home PN bags were excluded. Information captured included: total number of adult PN bags, type of PN bag, reasons for wastage or return, why bag could not be reallocated, number of bags reallocated and the cost of the PN bag. The price for each PN bag was calculated based on the cost breakdown from the monthly PbR PN reporting for aseptic services. Results were compared to data collected during a previous audit undertaken between April–July 2014. Results 627 PN bags were ordered during the audit period. Out of which 91% (n = 568/627) were used for intended patient (an increase of 1%); the financial cost of wasted PN was £6,217 per annum (a decrease of 62%); 69% (n = 41/59) were reallocated (increase of 5%); and the cost saving was £8,926 per annum (an increase of 37%). Conclusion The inclusion of a CNS and a pharmacist to the daily ward rounds as well as daily prescribing of adult PN bags significantly improved the utilisation of PN bags appropriately and minimised waste. A system to highlight which PN bags are available for reallocation should be introduced locally to avoid available bags not being utilised. Disclosure of interest None Declared.

A REVIEW OF THE USE OF THE TRUST'S STANDARD PARENTERAL NUTRITION BAGS FOR PAEDIATRIC PATIENTS

Standardised parenteral nutrition (PN) bags enable the provision of early nutrient supplies as well as having advantages by reducing microbiological contamination and compounding errors1 and their use is recommended by the Paediatric Chief Pharmacists Group.2 Aim To determine the uptake and suitability of the Trust9s current paediatric standard parenteral nutrition bags. Method Data was collected over a six month period from Jan-Jun 2013. Data on the number of bags ordered and wasted and the total volume and quantity of macronutrients was collected. Once the data was evaluated, patients prescribed an individualised bag where one of the current standard bags could have been used were highlighted. For patients who could not receive one of the current standard bags, details of bag volume and macronutrients were plotted on a scatter graph to compare the differences with the current standard bag compositions. Results There were 505 (78%) individualised and 148 (22%) standard bags ordered between Jan and Jun 2013. The high percentage of individualised bags leads to a higher cost to the Trust as the cost of an individualised bag is around £20 more expensive than the average standard bag as well as there being an increased work pressure on pharmacy resources and an increased risk of contamination. There were 54 out-of-date standard bags that were wasted over the data collection period leading to a cost of roughly £1,300. This is due to the poor uptake and the minimum order number for each of the current standard bags. The individualised bag compositions were reviewed and it was identified that only 16 (3%) patients could have received one of the current standard bags. The standard bags are already diluted to a pre-determined volume which was identified as a limiting factor for the complex surgical, gastroenterology and intensive care patients. The current standard bag compositions were based on the European Society for Clinical Nutrition and Metabolism (ESPEN) guidance. During the data collection it was noted that different members of the nutrition team were using either the Ball regimens or the ESPEN guidance, leading to different quantities of the macronutrients being ordered. Conclusion The current set of standard parenteral nutrition bags are not fit for purpose. The issues identified are that the current standard bag volumes limit their use in the more complex paediatric patients and there is no agreed Trust guidance available to assist with macronutrient ordering. The review has led to the development of a new set of standard bags being developed which will be more concentrated to allow for different volumes to be given and the development of Trust guidance on macro and micronutrient provision to enable a higher uptake of the new standard bags and reduce the cost in wastage.

Rouxiella chamberiensis gen. nov., sp. nov., a member of the family Enterobacteriaceae isolated from parenteral nutrition bags.

Parenteral nutrition bags for newborns were found contaminated by a previously undescribed member of the family Enterobacteriaceae. The six isolates studied by rrs gene (encoding 16S rRNA) sequence analysis and multi-locus sequence analysis (MLSA) formed a discrete branch close to the genera Ewingella, Rahnella, Yersinia,Hafnia and Serratia. Phenotypically, the new taxon was distinct from these five genera. The new taxon gave positive results in Voges-Proskauer, Simmons citrate and o-nitrophenyl-β-galactoside hydrolysis tests; fermented d-glucose, d-mannitol, l-rhamnose, melibiose, l-arabinose and d-xylose; hydrolysed aesculin; and did not ferment maltose, trehalose, raffinose, d-sorbitol, sucrose or cellobiose. Tests for motility, gas production, urease, gelatinase and nitrate reduction were also negative. All isolates failed to grow at 37 °C. The DNA G+C content of strain 130333T was 53 mol%. On the basis of data obtained in this study, the six isolates represent a novel species of a new genus in the family Enterobacteriaceae, named Rouxiella chamberiensis gen. nov., sp. nov. The type strain of the type species is 130333T ( = CIP 110714T = DSM 28324T).

Nutrition quality control in the prescription and administration of parenteral nutrition therapy for hospitalized patients.

Nutrition quality control in parenteral nutrition therapy (PNT) allows the identification of inadequate processes in parenteral nutrition (PN). The objective of this study was to assess the quality of PNT at a hospital with an established nutrition support team (NST). This observational, longitudinal, analytical, and prospective study examined 100 hospitalized PNT adult patients under the care of an NST for 21 days or until death/hospital discharge. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) 2007 guidelines for PNT prescription were followed. PNT indications were not in accordance with the A.S.P.E.N. 2007 guidelines in 15 patients. Among the remaining 85 patients, 48 (56.5%) did not receive adequate PNT (≥80% of the total volume prescribed). Non-NST medical orders, progression to and from enteral nutrition, changes in the central venous catheter, unknown causes, and operational errors (eg, medical prescription loss, PN nondelivery, pharmacy delays, inadequate PN bag temperature) were associated with PNT inadequacy (P < .005). Compared with patients who died, the discharged patients received PN volumes ≥80% on most days (P = .047). The quality indicators for nutrition therapy related to estimated energy expenditure and protein requirements and glycemia levels reached the expected targets; however, the central venous catheter infection rate was higher than 6 per 1000 catheters/d and did not meet the expected targets. Despite an established NST, there was a moderate level of PNT inadequacy in indications, administration, and monitoring. It is important to establish periodic meetings among different health professionals who prescribe and deliver PNT to define responsibilities and protocols.

Barium in intravenous solutions for administration to neonates: Origins and levels of contamination

Summary Background & aims Barium is a glass constituent and a component of plastic additives, and may migrate from containers and devices into solutions. As barium is a toxic element, all steps involved in the preparation of intravenous solutions for premature neonates in an intensive care unit were evaluated to determine to what degree, if any, they contribute to Ba load. Commercial solutions for parenteral nutrition (PN) and medications and the apparatus used for administration were analyzed for their Ba content. Bags after compounding, medications after their preparation, infusion sets, and syringes were also evaluated. Materials and methods Ba concentration was determined by atomic absorption spectrometry. Results Bags, burettes, syringes, rubber caps, and glass containers yielded Ba in levels ranging from 0.02 to 4.38 mg/g. The highest levels among the solutions were found in multivitamins, magnesium sulfate, and calcium gluconate at 262 μg/L, 193 μg/L, and 166 μg/L, respectively. Most medications did not have measurable Ba contamination. However, after dilution in syringes, all of them became contaminated, and the highest level was reached in dexamethasone samples at 1333 μg/L Ba. Compounded PN bags (n = 15) had a mean of 54.6 μg/L Ba. The content of the same bags after percolating the burette had a mean level of 94.2 μg/L Ba. Conclusion Barium is leached from container materials into solutions parenterally administered to preterm babies. The handling processes of compounding and delivering nutrition solutions and medicines increased the Ba intake by almost 3 fold in relation to its levels in the starting products.

5.7 Hyperalimentation and electrolyte requirements in very preterm infants: a randomised controlled parenteral nutrition study

BackgroundThe Standardised, Concentrated with Added Macronutrients Parenteral (SCAMP) nutrition regimen is a method of hyperalimentation shown to improve early head growth in very preterm infants.1 Early hyperalimentation has been associated...

Heparin stability in parenteral nutrition bags prepared in a neonatal intensive care unit

Heparin stability in parenteral nutrition bags prepared in a neonatal intensive care unit

OHP-010 Management of parenteral nutrition in the Intensive Care Unit of a third level hospital

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...