Total Parenteral Nutrition Bags Research Articles

Parenteral Nutrition in the Pediatric Oncologic Population: Are There Any Sex Differences?

Gender-based medicine is attracting increasing interest every day, but studies on pediatric populations are still limited. In this setting, sex differences among patients undergoing total parenteral nutrition (TPN) have not been previously reported. This study investigated the presence of sex differences in parenteral nutrition composition and outcomes among a cohort of pediatric patients admitted at the Oncohematology and Bone Marrow Transplant Unit of the Institute for Maternal and Child Health "Burlo Garofolo" of Trieste, Italy. For all 145 recruited patients (87 males, 58 females), the following data were collected: age, sex, volume and duration of TPN, macro- and micronutrient composition of TPN bags, electrolytic or blood gases imbalance, glycolipid alterations, liver damage during TPN, and the incidence of sepsis and thrombosis. The analysis showed that females required higher daily phosphate intake (p = 0.054) and essential amino acid supplementation (p = 0.07), while males had a higher incidence of hypertriglyceridemia (p < 0.05) and cholestasis. A higher incidence of sepsis was found in the non-transplanted male population (p < 0.05). No significant differences were appreciable in other analyzed variables. This study aims to create a basis for future gender-based nutritional recommendations in the pediatric field.

Dynamics of homeostasis in patients with acute pancreatitis, depending on the use of parenteral nutrition

The data of patients with severe acute pancreatitis (AP) who were treated for the period from 2014 to 2018 were analyzed. Patients who on the second day of intensive therapy experienced intestinal failure syndrome, which made it impossible to conduct early enteral nutrition, nutritional support began with a total parenteral nutrition (TPN). Depending on the type of mixture that was used as nutritional support, the patients were divided into subgroups: subgroup 1 (n = 22) - patients who received three-component mixtures in special TPN bags. Subgroup 2 (n = 20) - patients who received three-component mixtures with a high content of ω-3 fatty acids for TPN. Subgroup 3 (control) - patients (n = 25), in which the TPN consisted of separate modules of carbohydrates, amino acids and fats. It is shown that during severe AP accompanied by increased levels of cortisol in patients subgroups 1, 2 and 3 is 1.8, 1.7 and 1.9 times higher than normal, stress-induced hyperglycemia and hypoalbuminemia from the first day of the disease. Conducting modular TPN did not provide a protein-saving effect against the background of hypercatabolism caused by the course of severe acute pancreatitis. The addition of ω-3 FA in the composition of TPN by three-chamber bags contributed to a more rapid recovery of the level of total blood protein and albumin against the background of the course of severe AP. On the background of the nutritional support by TPN using the three-chambered bags of enriched ω-3 fatty acids, it has been registered normalization of neutrophil-leukocyte index at 7 days by reducing leukocytosis and a significant increase in blood levels of lymphocytes, a faster and more pronounced decrease in blood levels of CRP. It determined that in patients with severe AP 1 and 2 subgroups that received TPN using a three-chambered bags, the total period of hospital treatment (27,5 ± 2,7 days and 22.1 ± 0.8 days, respectively) was significantly less than in patients who underwent TPN using modular systems (35.5 ± 7.7 days) (p 1, 2 = 0.001, p1, 3 <0.001, p2, 3 <0.001).

Time span of a total parenteral nutrition bag: From consultation to the end of administration

Objective: A multidisciplinary nutrition support team (NST) aims to improve a patient’s nutritional status. Nutritional support should be initiated promptly in patients who need it. Parenteral nutrition (PN) solutions have a risk of being unstable until 24 hours after preparation. The aim of this study was to determine the time span of the PN process, which starts from a consultation with an NST until the end of the administration of the solution, to demonstrate the appropriateness of the practice. Methods: In this study, the timing of each process including NST consultation, evaluation of the patient by NST, delivery of the order label to the pharmacy, compounding process, delivery of the bags to the services/units, storage in the services/units, and duration of administration were prospectively followed and recorded by three pharmacists in a university hospital for two weeks in January 2017. Results: A total of 12 patients’ PN processes were followed and the duration of each stage was recorded by pharmacists. The mean duration of compounding PN±standard deviation (SD) was 5.18±0.87 minutes. The average (±SD) volume of PN was 1557±205.2 mL. The mean (±SD) duration of administration was recorded as 24 hours and 14 minutes±37.5 minutes. The mean (±SD) volume of residual PN solution was 106.9±30.3 mL and 41.6% of the waste was discarded as household waste rather than medical waste. The mean (±SD) room temperature during the administration of PN was 25.01±1.6°C. Conclusion: With regard to stability problems of PN solutions, awareness among healthcare professionals should be raised in order to reduce the waiting period till administration. Minimizing waste-cost and the residual volume of PN is important to maintain the patients’ nutritional requirements.

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.

TCH-045 Suitability of a Sensor-Driven, Single-Use Micro Dosing Valve For Volumetric Dispensing in a Modularly Assembled Multi-Channel Compounder

BackgroundMajor drawbacks of commercially available compounders are expensive prices, large-scale architecture (24 channels), restricted country support, and gravimetric dosing requiring periodically defined densities and flow factors. However, total parenteral nutrition...

OHP-082 Use of Standard Protocols For Total Parenteral Nutrition in a Tertiary University Hospital

BackgroundOne of the clinical pharmacist’s main functions in parenteral nutrition is to ensure the quality and safety of the solutions prepared. It is too laborious to do this with each...

Extending total parenteral nutrition hang time in the neonatal intensive care unit: Is it safe and cost effective?

To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload. A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload. One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442 g (±101) versus 2476 g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group; P < 0.05). Annual cost saving using 48-h TPN was AUD 97,603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced. Extending TPN hang time from 24 to 48 h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects.

Audit of pharmacy TPN services on the neonatal intensive care unit (NICU)

<h3>Objective</h3> At The Whittington Hospital, pharmacy is responsible for providing a total parenteral nutrition (TPN) service to neonatal intensive care unit (NICU). The aims are to deliver a safe and beneficial service to patients, which is also cost-effective to the Trust. Neonatal TPN bags are manufactured off-site, and there are two main types of bag procured: Standard Stock Bags and Tailor-Made Bags. This audit was designed to investigate the management and delivery of TPN to NICU in the Trust over a 12-week period, focusing on the type of bag prescribed, usage and the expenditure. This in turn helped to determine new local standards of management with the aim of optimising the TPN service, with reduced costs and wastage. <h3>Methods</h3> Data was collected over 12-weeks (19 October 2009 to 8 January 2010) and expenditure calculated with pricing adapted from JAC and the Service Level Agreement held with external suppliers. <h3>Results</h3> Table 1 summarises the types and cost of bag used over the audit period and the number of which incurred wastage. Where there were differences in the TPN prescription compared to the standard formula, tailor-made bags were ordered. Table 2 summarises the main changes made. <h3>Conclusion</h3> Findings from the audit showed a high usage of tailor-made TPN compared to stock TPN, most of which were bespoke bags (bags with additions made to the standard stock formula). Since conducting the audit practice has been reviewed: a new stock order level has been put in place, in addition a new TPN prescription has been developed, which helps distinguish between the different bags available. Although TPN requirements are based on the individual patient, the audit suggests that the stock bag may need to be reviewed for a more favourable alternative (and in-line with the latest ESPGHAN recommendations). A re-audit is intended, where it is hoped that optimised management of the pharmacy TPN service to NICU will be demonstrated.

Contamination of integral protective suits in the sterile environment used for producing total parenteral nutrition bags

Manufacturing of parenteral nutrition in a cleanroom requires a strict survey of environmental microbiological contamination. In the cleanroom of our hospital's pharmacy, the staff wears integral protective suits made of polyester with an open hood, the main function of which is to protect the products and the environment from any human contamination. The objective of this study was to determine the level of microbiological contamination of the suits during the production process at several spots on the clothing and at different times; and then to evaluate the impact of the use of an additional protection, namely, sterile single-use polyethylene arm-cover sleeves. First, 160 samplings, taken with agar contact plates, were carried out on the coveralls of staff working in an A-Class (ISO 5) cleanroom at T = 0, 1, 2, 3, 4, and 5 hours of presence in the room. Then, after the introduction of additional protective sleeves, 120 samplings (60 above and 60 under the protective arm sleeves, worn over the coveralls) were carried out. The study showed that microbiological contamination increases with time, sometimes after 1 hour of stay in the cleanroom room. Forearms are the crucial site of contamination, and the use of arm covers is hence recommended. Dans le processus de fabrication de poches de nutrition parentérale en zone à atmosphère contrôlée (ZAC), la maîtrise de la contamination microbiologique de l’environnement est une priorité. Dans l’unité de nutrition parentérale de l’hôpital Armand-Trousseau, le personnel est revêtu de combinaisons intégrales stériles en polyester dont le rôle premier est de protéger l’environnement et les préparations de toute contamination d’origine humaine. L’objectif de cette étude a été de déterminer la contamination microbiologique des combinaisons en cours de fabrication, puis d’évaluer l’impact de l’utilisation d’une protection complémentaire, des protège-bras en non-tissé stériles à usage unique. Dans un premier temps, un total de 160 prélèvements sur les casaques, par géloses de type « contact », ont été réalisés sur le personnel manipulant en classe A à différents temps de présence dans l’unité. Dans un second temps, après la mise en place des protège-bras, 120 prélèvements (60 sur les protège-bras, 60 sur la combinaison sous les protège-bras) ont été effectués. Cette étude a montré que la contamination microbiologique augmente au cours du temps et les normes sont dépassées après une heure de présence dans la ZAC. Les avant-bras constituent le site le plus critique et l’utilisation de protège-bras réduit la contamination microbiologique de cette zone.

Analysis of Sodium and Potassium in Total Parenteral Nutrition Bags by ICP-MS and ICP-AES:Critical Influence of the Ingredients

The compounding of total parenteral nutrition solutions (TPN) in the hospital pharmacy is a high-risk activity for which a quality assurance programme is necessary. The complexity of parenteral nutrition solutions containing almost 50 ingredients makes it difficult to measure each of them. On the other hand, the assay of electrolytes such as sodium and potassium is accepted as a quality marker for estimating compounding errors. Thus, the aim of this study was to estimate the influence of ingredients on the accuracy of assays of electrolytes. Experiments were performed with aqueous working simulated solutions of sodium and potassium prepared by the addition of each nutrient step by step, (dextrose, amino acids, lipids, vitamins and trace elements). Sodium and potassium levels were measured by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS) and Atomic Emission Spectroscopy (ICP-AES). The performance of these methods was compared using statistical evaluations (t-test and Mann–Whitney test).The study highlights the interference of amino acids, vitamins and trace elements when measuring sodium, but no interference was noted during the measurement of potassium. To reduce the risk and to improve the quality of compounding, we used an automated compounding device but, even in this case, the acceptance criterion for sodium and potassium determination was not <10%.

Supplémentation en vitamine K lors de la nutrition parentérale chez l’enfant

The supplementation of vitamin K is necessary for total parenteral nutrition (TPN) patient to avoid hemorrhagic risk. In home TPN and to simplify the children administration, the vitamin K could be added once or twice monthly in admixtures. The aim of this work was to evaluate the vitamin K stability (20 mg/L) in usual conditions of administration (binary or ternary mixtures, at room temperature and at artificial light for 24 hours) and at storage (binary mixtures protected from light, at 4 °C for 12 hours). Each step of the study was performed with quantification using HPLC method coupled with UV detection at 244 nm on five TPN bags. The results of this study show that the vitamin K was stable for 24 hours at light exposure and at room temperature in binary mixture (96.6%) also ternary (99.8%). The vitamin K was stable at 4 °C for 12 days (98.4%). This work shows that vitamin K can be added directly in TPN and could avoid painful intramuscular injection. Such nutritional admixtures could be prepared beforehand and allow administration at home. This practice is actually consensual in gastro-enterology department at Necker University Hospital. A clinical and biologic monitoring is essential.

Shielding Parenteral Nutrition From Light: Does the Available Evidence Support a Randomized, Controlled Trial?

Exposure of total parenteral nutrition to ambient light induces the generation of peroxides, creating oxidant stress, which potentially compounds complications of prematurity. Photograph protection of total parenteral nutrition reduces the peroxide load and has been shown to be associated with nutritional and biochemical benefits in animals and humans. It is unclear whether this reduction in peroxides from total parenteral nutrition leads to a reduction in the complications of prematurity, such as bronchopulmonary dysplasia. Our hypothesis was that shielding total parenteral nutrition from ambient light is linked to clinical benefits. The purpose of this work was to determine whether photograph protection of total parenteral nutrition (light protected), as compared with no photoprotection (light exposed), reduces the occurrence of bronchopulmonary dysplasia or death in preterm infants. The Canadian Neonatal Network provided data for infants born in 2006 at <28 weeks' gestation admitted to level 3 NICUs in Canada. A retrospective analysis was performed comparing bronchopulmonary dysplasia and death in infants who received light-exposed or light-protected parenteral nutrition. Data were analyzed by using logistic regression models. RESULTS. Thirteen NICUs offered partial light-protected (total parenteral nutrition bag only, intravenous tubing exposed) and 13 offered light-exposed parenteral nutrition; not a single NICU offered complete light-protected parenteral nutrition (total parenteral nutrition bag plus intravenous tubing). The incidence of bronchopulmonary dysplasia or death was 66% with light-protected (n = 428) vs 59% with light-exposed (n = 438) parenteral nutrition. Partial photograph protection of total parenteral nutrition was not associated with a reduction in bronchopulmonary dysplasia or death as compared with no photograph protection; this relationship is confounded by covariates with strong associations with bronchopulmonary dysplasia. Partial photograph protection of total parenteral nutrition solutions confers no clinical benefit, while consuming valuable resources. A randomized, controlled trial is justified to determine whether there is a true "cause-and-effect" relationship between complete photoprotection of total parenteral nutrition and bronchopulmonary dysplasia or death.

Physical compatibility of neonatal total parenteral nutrition admixtures containing organic calcium and inorganic phosphate salts in a simulated infusion at 37°C*

Within an incubator environment at 37 degrees C, we evaluated the physical compatibility of calcium (Ca) and phosphate (P) in simulated neonatal total parenteral nutrition (TPN) infusions. Representative neonatal TPN formulas containing four concentrations of amino acids [AA] (1-4 g/dL) and two levels of dextrose [D] (5 and 10 g/dL) were monitored for calcium-phosphate precipitate formation over 24 hours using a laser-based particle counting technique. Research Laboratory. None. Of the eight AA-D combinations studied, two formulas containing 1 g/dL AA with either 5 g/dL or 10 g/dL of D and high amounts of Ca and P resulted in significant increases in particle counts and visibly evident precipitation during the 24-hour infusion. Precipitation was noted only after the infusion passed through the incubator, but not in the TPN bags, demonstrating the heightened risk of calcium-phosphate incompatibility with increased temperatures. Low AA concentrations and high temperatures are significant risk factors for the precipitation of the insoluble dibasic calcium phosphate that may be fatal upon intravenous infusion. When thermoregulation is required, the AA concentration of the TPN formula should not be less than 1.5 g/dL (and ideally > or =3 g/dL) when high intakes of calcium (60 mg/dL) and phosphate (46.5 mg/dL) are prescribed.

Insulin Management of Diabetic Patients on General Medical and Surgical Floors

To review the standardized subcutaneous insulin protocols for diabetic patients on general medical and surgical floors at the University of Vermont. Insulin protocols were developed for inpatients eating regular meals, and those receiving continuous tube feedings or total parental nutrition. The recommended starting subcutaneous insulin protocol for patients receiving meals is a basal-bolus approach using 0.5 U/kg basal insulin (glargine once daily, or neutral protamine Hagedorn [NPH] twice daily) and 0.1 U/kg rapid analog at each meal (lispro, aspart, or glulisine) for the average patient. The dose of basal is lowered by 0.2 U/kg for medical conditions with a high sensitivity to insulin or that have an added risk for hypoglycemia (renal or hepatic impairment, thin or normal weight, elderly, frail, hypothyroidism, adrenal insuffi ciency, etc.). Alternatively, an extra 0.2 U/kg basal is given for states of presumed high insulin resistance such as marked obesity with metabolic syndrome, open wounds, infections, etc. In turn, patients receiving continuous tube feedings receive the same 24-hour insulin doses (0.6-1.0 U/kg) in divided doses of premixed 70/30 (NPH/regular) insulin every 8 hours. This program allows lowering or eliminating 1 of the doses for the increasingly common tube-feeding programs in rehabilitation centers or patients' homes that entail discontinuation of tube feeding for 6 to 8 hours. A variation on this approach is used with total parenteral nutrition (TPN), with a portion of the insulin placed in the TPN bag and the remainder given as "q 8 hour 70/30" insulin. Starting insulin doses for all of the programs are adjusted daily to attain inpatient blood glucose goals of <110 mg/dL fasting and 110 to 180 mg/dL throughout the day. Standardized protocols have been developed and implemented at the University of Vermont for patients receiving regular meals and continuous tube feedings or TPN.

Ergonomic and economic aspects of total parenteral nutrition

Ergonomics in total parenteral nutrition include the work performed in the (hospital) pharmacy and on the medical ward. This article reviews the developments in total parenteral nutrition ergonomics and the related cost-savings. Research focuses on the ergonomic advantages of multi-compartment total parenteral nutrition bags compared with the multi-bottle system, of multi versus single-layered total parenteral nutrition bags and of the presence of a nutritional team and training in clinical nutrition to improve regimen prescription and delivery. Three-compartment bags are safe, economic and ergonomic. It is important, however, to keep the knowledge of pharmacies to compound total parenteral nutrition for children and (adult) patients with specific pathologies. Research is ongoing in the development of bags with more than three compartments, to include for instance vitamins. This necessitates improvements in bag materials and wrapping. Progress can be made regarding total parenteral nutrition prescription and delivery, as well as in the incidence of related infections by promoting training in clinical nutrition and the implementation of a multidisciplinary nutritional support team.

Evaluation of childhood exposure to di(2-ethylhexyl) phthalate from perfusion kits during long-term parenteral nutrition

Leachability of the plasticizer di(2-ethylhexyl) phthalate (DEHP) from administration sets into intravenous parenteral emulsions containing fat was investigated. DEHP is added to polyvinyl chloride (PVC) to impart flexibility. However, DEHP is a lipid-soluble suspected carcinogen that is hepatotoxic and teratogenic in rodents, and has been shown to leach from PVC products containing lipophilic mixtures. Consequently, total parenteral nutrition (TPN) mixtures containing fat emulsions should be stored in ethylvinyl acetate (EVA) bags rather than PVC packs. However, while TPN bags are made of EVA, they contain PVC-DEHP residues and the lines used between TPN bags and venous catheters are made of PVC-DEHP. The present study quantified the amount of DEHP leached from bags and tubing that could potentially contaminate patients during home TPN. Four types of emulsions containing fat were studied. Levels of DEHP in the bag and at the outlet tubing were measured by high-performance liquid chromatography (HPLC). This was measured during simulated TPN at different times after starting perfusion, 1 day after reconstitution of solutions in the bags, and 1 week later after storage at 4 °C. Detectable and stable amounts of DEHP were found to leach from bags (0.2±0.008 mg to 0.7±0.02 mg) and DEHP content increased in the outlet tubing (0.8±0.09 mg to 2±0.07 mg) during simulated infusions. The same phenomenon was observed after 1 week of storage at 4 °C. DEHP extraction by TPN depends on the lipid content of each TPN preparation and the flow rate. These results suggest that children treated with prolonged TPN are regularly exposed to significant amounts of DEHP.

輸液と総合ビタミン注射製剤の混合によりＴＰＮ投与セットにおける滴下速度の減少をもたらす原因の解明

It is well known that controlling the infusion rate is necessary, when administering total parenteral nutrition (TPN). We recently observed a significant reduction in the flow rate caused by several brands of TPN administration using Hicaliq® RF (HRF) mixed with total vitamin injection. In the present study, we investigated the flow rate reduction mechanism between several bands of TPN. The flow rate decreased in cases of TPN solution mixed with some vitamins for injection which contained lipophilic vitamins. These vitamins contained polyoxyethylene (20) sorbitan monooleate as a solubilizer of lipophilic vitamin. A reduction of the flow rate was observed in the TPN administration sets using an in-line filter which has a symmetric membrane structure, whereas the filter of the asymmetric membrane structure in the TPN administration set did not show a flow rate reduction. The lowest flow rate was observed in HRF, of all the TPN solutions used in the present study because 50% glucose in HRF showed a higher viscosity. There is possibility that an unstable flow rate was obtained in the case of a positioning failure of the TPN bag caused by the patient, when administering HRF mixed with polyoxyethylene (20) sorbitan monooleate containing total vitamins for injection.

Physical characteristics of total parenteral nutrition bags significantly affect the stability of vitamins C and B1: a controlled prospective study.

Vitamin degradation occurring during the storage of total parenteral nutrition (TPN) mixtures is significant and affects clinical outcome. This study aimed to assess the influence of the TPN bag material, the temperature, and the duration of storage on the stability of different vitamins. Solutions of multivitamin and trace elements at recommended doses were injected into either an ethylvinyl acetate (EVA) bag or a multilayered (ML) bag filled with 2500 mL of an identical mixture of carbohydrates (1200 kcal), fat (950 kcal), and amino acids (380 kcal). The bags were then stored at 4 degrees C, 21 degrees C, or 40 degrees C. Concentrations of vitamins A, B1, C, and E were measured up to 72 hours after compounding, using high-pressure liquid chromatography. Ten percent to 30% of vitamin C degradation occurred within the first minutes after TPN compounding. Vitamin C was more stable in ML bags (half-life: 68.6 hours at 4 degrees C, 24.4 hours at 21 degrees C, and 6.8 hours at 40 degrees C) than in EVA bags (half-life: 7.2 hours at 4 degrees C, 3.2 hours at 21 degrees C, and 1.1 hour at 40 degrees C). Moreover, appearance of dehydroascorbic acid in the TPN mixture did not compensate for vitamin C losses. Vitamin B1 was stable at 21 degrees C, but a 43% loss occurred at 40 degrees C after 72-hour storage in EVA bags. The other vitamins were stable in the TPN mixture stored in both bags at any temperature and without daylight protection. Degradations of vitamins C and B, are significantly reduced in ML bags compared with EVA bags. To prevent vitamin C deficiencies, its initial dose should be adapted to its degradation rate, which depends on the TPN bag material, the ambient temperature, and the length of time between TPN compounding and the end of infusion to the patient.

Quantitative determination of fat emulsion using 1,6-diphenyl-1,3,5-hexatriene as fluorescence probe: application to the compounding of all-in-one parenteral nutrition admixtures.

The potential contamination of binary bags by traces of fat emulsion stemmed from ternary bags prepared just before, led us to determine traces of lipids into the line set of the automated compounder MM23. Diphenylhexatriene (DPH) was chosen as fluorescence probe due to its strong fluorescence enhancement in a lipid environment. Optimization of experimental conditions (i.e. DPH amounts, pH of fat emulsion samples, ultrasounds use, light, temperature and contact duration) for fluorescence measurement and validation of analytical method were performed. This method was linear over 0.5-8.0 mg l(-1) (r=0.999) of fat emulsion. The intra-day and inter-day precisions were inferior to 2% for the 2.0 and 8.0 mg l(-1) standards. Under optimized conditions, the detection limit and quantitation limit were 0.10 and 0.29 mg l(-1) of lipids respectively. Compared to the colorimetric method using sodium dichromate, it is at least 100 times more sensitive. The proposed method permitted to rapidly measure fat emulsion traces in automated compounder line set for parenteral nutrition solutions and thus, to assess the risk of contamination of binary bags by lipids. At last, this method was shown to be conveniently applied to the analysis of fat emulsion in the final total parenteral nutrition bag.

Economic investigation of the use of three-compartment total parenteral nutrition bag: prospective randomized unblinded controlled study

Optimal strategy for total parenteral nutrition (TPN) administration is essential both in terms of clinical effectiveness and economic efficiency. The aim of the present economic analysis was to provide a systematic and comprehensive cost comparison of the application of three currently available TPN systems: Separate Bottles (SB), Hospital-Compounded Bags (HCB) and Three-Compartment Bags (TCB). Sixty patients, admitted to the Geneva University Hospital and requiring TPN, were randomly assigned to one of the three systems. Three standard TPN formulas were prescribed to meet the patients' protein energy needs. TPN-related activities of medical, nursing and pharmacy staff were timed for the 24 hours of TPN administration. Manpower, nutrient solutions and medical supplies costs were calculated on the basis of mean Swiss salaries and hospital prices. TCB was the least expensive TPN system. SB and HCB systems' application costs were 120 and 150% of TCB cost, respectively. All intersystems cost comparisons were statistically significant (ANOVA p≤0.01). SB system required more items and manipulations, resulting in higher nurses manpower cost. Pharmacy overhead cost due to compounding was responsible for the higher cost of HCB system. Detailed manpower data presented in this study allow for an estimation of TPN application costs in other hospitals, using local salaries, specific product prices and compounding costs.