Commercial Premixed Parenteral Nutrition: Is It Right for Your Institution?

Miller, Sarah J.

doi:10.1177/0884533609339067

Cited by 27 publications

(45 citation statements)

References 38 publications

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“…[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. First, an actual cost comparison of the present study would have provided us with more realistic data, if this hospital had been using the 2 systems simultaneously.…”

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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“…58 Three factors to be considered in making the final determination are the evaluation of clinical outcomes, safety, and cost. 59 Because of the limited availability of commercial products, many clinicians find that "premixed" PN formulations often will not meet the caloric, amino acid, and electrolyte needs of critically ill patients, who are often obese, require fluid restriction, and display hepatic/ renal dysfunction. These products have particularly been criticized for their high dextrose concentrations, which could increase the risk of hyperglycemia and infection.…”

Section: Strongmentioning

confidence: 99%

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

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

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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“…The impact of end product tested commercial standardised feeds on safety is likely to be small, and does not provide a powerful argument in favour of their use. There may be cost savings involved in the use of standardised feeds, but on this point the literature contains conflicting data (23) and an assessment from industry is that costs are not likely to be lowered and may in fact be increased. (24) It is almost certainly the case that a proportion of patients can be managed perfectly well in terms of nutritional outcomes with a range of standardised feeds.…”

Section: Discussionmentioning

confidence: 99%

Safe parenteral nutrition and the role of standardised feeds

Puntis

2010

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Commercial Premixed Parenteral Nutrition: Is It Right for Your Institution?

Cited by 27 publications

References 38 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

Safe parenteral nutrition and the role of standardised feeds

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