Basic principles for compounding all-in-one parenteral nutrition admixtures

Abstract

Parenteral nutrition admixtures are complex pharmaceutical entities. The more closely they are examined, the more physico-chemical interactions emerge that could potentially affect stability. The move towards large scale hospital or commercial preparation, with a requirement for extended shelf life, and the increasing use of admixtures as vehicles for drugs and pharmaconutrients have created new formulation challenges for pharmaceutical scientists.

Parenteral Nutrition in Neonatus and Compatibility Issues: a Review Article

“…The risk of catheter-related bloodstream infection remains one of the most serious complications associated with PN [101]. Temporary or short-term central venous catheters account for about 90% of nosocomial blood stream infections, and only 10% of infections are from long-term devices such as tunneled catheters or implanted reservoirs [102].…”

“…The patients can also develop local site infections, port pocket infections, or catheter tunnel infections without developing a full blood stream infection. Signs and symptoms associated with catheter-related sepsis include fever, rigors, malaise, defervescence of fever after catheter removal, and positive blood cultures [102]. Treatment options include catheter removal, antibiotic lock, or delivery of systematic antibiotics via the catheter [93].…”

“…The variety of PN regimens and of drug dosages is huge. Therefore, pharmaceutical expertise is mandatory for safe and effective treatment [88,101,102].…”

“…AIO mixtures constitute the standard for PN; in the ready to use form they show restricted stability and shelf life. The high number of chemically reactive components and the oil/water (o/w) emulsion character of lipid-containing AIO admixtures represent a most complex vehicle for drug admixing [102]. Incompatibilities may result from direct reactions between soluble components but also from reactions with the container material or with the gas (oxygen) present in the container.…”

“…Reduced repulsion forces between the oil droplets eventually lead to irreversible creaming and oiling out [1,102,104]. …”