A Reproducible and Individualized Method to Predict Osmolality of Compounded Pediatric Parenteral Nutrition Solutions

Petitcollin, Antoine; Duval, Stéphanie; Bouissou, Antoine; Bourgoin, Hélène

doi:10.1177/0148607115570695

Cited by 3 publications

(14 citation statements)

References 24 publications

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“…However, one study suggested that the commonly used estimation method may underestimate the true osmolality of compounded formulations. Although a new predictive method has been proposed, it requires additional research to validate its accuracy 20 . When peripheral PN use is necessary, the intravenous site must be monitored frequently for signs of phlebitis.…”

Section: Question 6: In Which Patients Is Peripheral Pn a Reasonable mentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

176

202

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Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings. (JPEN J Parenter Enteral Nutr. 2017;41:324-377) The etiology-based nutrition diagnoses in adults in clinical practice settings are as follows: Starvation-related malnutrition: Chronic starvation without inflammation (eg, anorexia nervosa). Chronic disease-related malnutrition: Inflammation is chronicand of mild to moderate degree (eg, organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity). Acute disease or injury-related malnutrition:Inflammation is acute and of severe degree (eg, major infection burns, trauma, closed head injury). 2,3Malnutrition, pediatric: An imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. It is recommended that growth charts based on a standard deviation z score system be used to track and assess nutrition status in children. 4,5Nutritionally-at-risk: Consider the individual nutritionally-atrisk if any of the following is present. Nutritionally-At-Risk Adult Summary of RecommendationsThese consensus recommendations are designed to identify best practices, guide day-to-day clinical decisions, reduce variations in practice, and enhance patient safety. They are not intended to supersede the judgment of the healthcare professional based on the circumstances of the individual patient.

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Section: Question 6: In Which Patients Is Peripheral Pn a Reasonable mentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

176

202

View full text Add to dashboard Cite

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“…Since osmolality can only be measured after the solution is mixed, it is impractical to determine in practice, and therefore the calculated osmolarity, a theoretical value, is used to approximate the compounded PN osmolality. Preliminary studies in Europe and this study suggest that calculated osmolarity (mOsm/L) underestimates osmolality (mOsm/kg), determined by direct measurement, in individually compounded PN solutions administered to NICU patients . Furthermore, these findings raise the possibility that prior clinical studies may have incorporated an underestimate of PN osmolality, thereby introducing a systematic bias in the existing literature on this topic.…”

Section: Clinical Relevancy Statementmentioning

confidence: 64%

“…Risk of peripheral IV infiltration increases at higher levels of infusion osmolality, accounting for 23%–78% of complications related to PN administration in neonates . Probability of infiltration is likely a function of many factors, in addition to osmolality of the PN solutions . PN osmolality (mOsm/kg) is typically estimated from calculated osmolarity (mOsm/L) using preset manufacturer algorithms that reflect local solution composition .…”

Section: Introductionmentioning

confidence: 99%

“…Probability of infiltration is likely a function of many factors, in addition to osmolality of the PN solutions . PN osmolality (mOsm/kg) is typically estimated from calculated osmolarity (mOsm/L) using preset manufacturer algorithms that reflect local solution composition . Despite this, clinical guidelines are based on calculated osmolarity.…”

Section: Introductionmentioning

confidence: 99%

“…Despite this, clinical guidelines are based on calculated osmolarity. The American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines recommend an upper osmolarity limit of 900 (mOsm/L) for peripheral PN administration in adults to minimize preventable harm due to osmolality, including phlebitis, extravasation, and infiltration . Expert consensus thresholds for maximum osmolarity of infusion solutions for peripheral and central PN administration vary between institutions .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A New Model for Non‐Lipid Compounded Neonatal Parenteral Nutrition Solution Osmolality

Borenstein

Mack

Palmer

et al. 2018

J Parenter Enteral Nutr

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Calculated osmolarity (mOsm/L) significantly underestimates the osmolality (mOsm/kg) in compounded PN. We developed a new algorithm to more accurately predict PN osmolality based upon calculated osmolarity from commercial software and composition of neonatal basic nutrient solutions used in North America. We propose that use of this PN algorithm will facilitate future studies to determine whether a causal association exists between PN osmolality and adverse events, and to establish safe thresholds for PN concentration in neonates.

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Enteral and parenteral nutrition considerations in pediatric patients

Cober

Gura

2019

American Journal of Health-System Pharmacy

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Purpose Current clinical practice guidelines on management of enteral nutrition (EN) and parenteral nutrition (PN) in pediatric patients are reviewed. Summary The provision of EN and PN in pediatric patients poses many unique considerations and challenges. Although indications for use of EN and PN are similar in adult and pediatric populations, recommended EN and PN practices differ for pediatric versus adult patients in areas such as selection of EN and PN formulations, timing of EN and PN initiation, advancement of nutrition support, and EN and PN goals. Additionally, provision of EN and PN to pediatric patients poses unique compounding and medication administration challenges. This article provides a review of current EN and PN best practices and special nutrition considerations for neonates, infants, and other pediatric patients. Conclusion The provision of EN and PN to pediatric patients presents many unique challenges. It is important for pharmacists to keep current with pediatric- and neonatal-specific guidelines on nutritional management of various disease states, as well as strategies to address compounding and medication administration challenges, in order to optimize EN and PN outcomes.

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A Reproducible and Individualized Method to Predict Osmolality of Compounded Pediatric Parenteral Nutrition Solutions

Cited by 3 publications

References 24 publications

When Is Parenteral Nutrition Appropriate?

When Is Parenteral Nutrition Appropriate?

A New Model for Non‐Lipid Compounded Neonatal Parenteral Nutrition Solution Osmolality

Enteral and parenteral nutrition considerations in pediatric patients

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