A.S.P.E.N. Statement on Parenteral Nutrition Standardization

Kochevar, Marty; Guenter, Peggi; Holcombe, Beverly; Malone, Ainsley; Mirtallo, Jay M.

doi:10.1177/0148607107031005441

Cited by 96 publications

(76 citation statements)

References 39 publications

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“…The decision whether to prepare PN admixtures internally or to purchase commercial products should be based on the type and size of a given hospital. [10][11][12] Safety, economic, and ergonomic aspects are all factors that should be taken into consideration while administering PN in a given hospital. 13,14 This retrospective observational study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

Cost Analysis of Premixed Multichamber Bags versus Compounded Parenteral Nutrition: Breakeven Point

et al. 2014

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Background: Industrially premixed multichamber bags or hospital-manufactured compounded products can be used for parenteral nutrition. The aim of this study was to compare the cost of these 2 approaches. Materials and Methods: Costs of compounded parenteral nutrition bags in an university hospital were calculated. A total of 600 bags that were administered during 34 days between December 10, 2009 and February 17, 2010 were included in the analysis. For quality control, specific gravity evaluation of the filled bags was performed. Results: It was calculated that the variable cost of a hospital compounded bag was $26.15. If we take the annual fixed costs into consideration, the production cost reaches $36.09 for each unit. It was estimated that the cost for the corresponding multichamber bag was $37.79. Taking the fixed and the variable costs into account, the breakeven point of the hospital compounded and the premixed multichamber bags was seen at 5,404 units per year. In specific gravity evaluation, it was observed that the mean and interval values were inside the upper and lower control margins. Conclusion: In this analysis, usage of hospital-compounded parenteral nutrition bags showed a cost advantage in hospitals that treat more than 15 patients per day. In small volume hospitals, premixed multichamber bags may be more beneficial.

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Section: Discussionmentioning

confidence: 99%

Cost Analysis of Premixed Multichamber Bags versus Compounded Parenteral Nutrition: Breakeven Point

et al. 2014

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“…Consensus Recommendation determined that the basis for identifying the best delivery system should be predicated upon the number and type of patients requiring PN within a specific healthcare organization. 57 The British Pharmaceutical Nutrition Group concluded that the appropriateness of the patient and the decision to use "premixed" PN formulations must be determined by appropriately trained nutrition support clinicians. 58 Three factors to be considered in making the final determination are the evaluation of clinical outcomes, safety, and cost.…”

Section: Strongmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

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236

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Background: Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation. Method: A systematic review of the best available evidence was used by an expert work group to answer a series of questions about PN prescribing, order review, compounding, labeling, and dispensing. Concepts from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format were applied as appropriate. The specific clinical guideline recommendations were developed using consensus prior to review and approval by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. The following questions were addressed: (1) Does education of prescribers improve PN ordering? (2) What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration? (3) What are the appropriate calcium intake and calciumphosphate ratios in PN for optimal neonatal bone mineralization? (4) What are the clinical advantages or disadvantages of commercially available premade ("premixed") multichambered PN formulations compared with traditional/customized PN formulations? (5) What are the clinical (infection, catheter occlusion) advantages or disadvantages of 2-in-1 compared with 3-in-1 PN admixtures? (6) What macronutrient dosing limits are expected to provide for the most stable 3-in-1 admixtures? (7) What are the most appropriate recommendations for optimizing calcium (gluconate) and (Na-or K-) phosphate compatibility in PN admixtures? (8) What micronutrient contamination is present in parenteral stock solutions currently used to compound PN admixtures? (9) Is it safe to use the PN admixture as a vehicle for non-nutrient medication delivery? (10) Should heparin be included in the PN admixture to reduce the risk of central vein thrombosis? (11) What methods of repackaging intravenous fat emulsion (IVFE) into smaller patient-specific volumes are safe? (12) What beyond-use date should be used for (a) IVFE dispensed for separate infusion in the original container and (b) repackaged IVFE? (JPEN J Parenter Enteral Nutr. 2014;38:334-377)

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“…No obstante, aunque se defiende su uso en ciertas circunstancias, como determinadas complicaciones clínicas, falta de aceptación de otras alternativas de realimentación o contraindicaciones de nutrición enteral 79 , se ha criticado su uso en la anorexia nerviosa, incluso su adecuación ética 80 . En cualquier caso, como en otros problemas mé-dicos, la nutrición parenteral debe usarse cuando no se pueda, o no se deba, utilizar el tubo digestivo como vehículo de alimentación 33,78,81,82 .…”

Section: Nutrición Artificialunclassified

Revisión del tratamiento dietético-nutricional de la anorexia nerviosa

Jáuregui‐Lobera

Bolaños-Ríos

2012

Rev. méd. Chile

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Review of nutritional and dietary management of anorexia nervosaFax: +34954278167 E-mail: ijl@tcasevilla.com L a anorexia nerviosa es un trastorno habitualmente de curso prolongado, con manifestaciones psicofísicas diversas 1 . Un porcentaje de pacientes puede morir, por suicidio o complicaciones físicas, siendo frecuente la muerte súbita por cardioarritmias 1-3 , que no guarda relación con la duración de la enfermedad o la edad, pero sí con un índice de masa corporal (IMC) < 12 y niveles muy bajos de albúmina sérica 4 , aunque el riesgo de dicho desenlace es poco predecible, dada la variable respuesta individual a la desnutrición y la influencia de otros factores 5,6 . En las complicaciones influyen el bajo peso, atracones, conductas purgativas, ejercicio extenuante y autolesiones 4 , siendo reversibles con una adecuada recuperación ponderal 7 . La prevalencia del trastorno es 0,2-0,5% 8 , afectando más a las mujeres 9 , pero con iguales efectos en los varones 10 . Aún sin demostrar que la ratio mujeres-hombres esté cambiando, lo que sí ha aumentado es el rango de edad de aparición, considerando que el rango tradicional de afectación era de 15 a 24 años para la mayoría de los casos 1 .La morbi-mortalidad asociada y la compleja naturaleza del trastorno, implican un tratamiento interdisciplinar 11 , muchas veces intensivo 12 , siendo los dietistas-nutricionistas los mejor cualificados para manejar aspectos dietético-nutricionales 13 , como el restablecimiento ponderal, el logro de una ingesta que cubra los requerimientos y una adecuada educación nutricional 4 .El objetivo del trabajo fue revisar los aspectos dietético-nutricionales del tratamiento de la anorexia nerviosa, enfatizando las tareas y estándares necesarios a proporcionar por parte de los dietistas-nutricionistas en el contexto de un equipo interdisciplinar y en diferentes ámbitos: ambulatorio, hospitalario y de hospitalización parcial (unidades de día). Material y MétodosSe hizo una revisión selectiva de las publicaciones indizadas en PubMed, sin carácter de revisión sistemática ni metaanálisis. Se incluyeron trabajos relacionados con el tratamiento dietético-

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A.S.P.E.N. Statement on Parenteral Nutrition Standardization

Cited by 96 publications

References 39 publications

Cost Analysis of Premixed Multichamber Bags versus Compounded Parenteral Nutrition: Breakeven Point

Cost Analysis of Premixed Multichamber Bags versus Compounded Parenteral Nutrition: Breakeven Point

A.S.P.E.N. Clinical Guidelines

Revisión del tratamiento dietético-nutricional de la anorexia nerviosa

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