Lipid Injectable Emulsion Survey With Gap Analysis

Abstract

These findings demonstrate the need for ongoing dissemination and education on standardized safe practices for ILE use.

Use of Intravenous Lipid Emulsions With Parenteral Nutrition: Practical Handling Aspects

“…The American Society for Parenteral and Enteral Nutrition (ASPEN) published the results of a national survey on ILE use with a gap analysis . The results indicated that a majority in the United States still provide compounded PN to meet their patients’ needs.…”

“…It was of great interest to note that only 5 or fewer PN admixtures were prepared by those institutions caring for 50% of adults, 82% of pediatrics, and 64% of neonates . Of the 16% minority using commercial MCB PN products in the United States, nearly 5% add separate ILEs to their 2‐chambered PN . Three‐chambered PN commercial products contain 3 macronutrients, each in a separate compartment, with or without electrolytes; vitamins and trace elements are added extemporaneously to the bag when prepared for the patient.…”

“…Among other issues, an ASPEN survey identified that the majority of organizations in the United States that care for pediatric and neonatal patients repackaged their original ILE products into smaller volumes . This practice is also common in Europe .…”

“…To reduce risk from infusing potentially contaminated repackaged ILEs, the duration of infusion is best limited to a maximum of 12 hours, though disagreement remains on this issue in both the United States and Europe (statement 43). In many settings in the United States and in Europe, the practice remains to allow a 24‐hour maximum infusion duration if the repackaging is performed under aseptic conditions in the pharmacy . However, it should be noted, from the limited literature on this subject, that even repackaging using an automated compounder in an aseptic environment was still associated with a contamination risk …”

“…The ASPEN survey on ILE use revealed that most organizations in the United States administer ILEs separate from the rest of the PN admixture (43% adult, 57% pediatric, and 89% neonatal) . Otherwise, the ILE is included as part of the PN admixture in 38% of adult, 18% of pediatric, and 6% of neonatal patients . Other organizations make both options available to their patients (19% adult, 25% pediatric, and 6% neonatal) .…”