Parenteral Nutrition Trace Element Product Shortage Considerations

Plogsted, Steve; Adams, Stephen; Allen, Karen; Cober, M. Petrea; Greaves, June; Mogensen, Kris M.; Ralph, Amy; Robinson, Daniel T.; Ward, Ceressa T.; Ybarra, Joe; Holcombe, Beverly

doi:10.1177/0884533616670374

Cited by 22 publications

(25 citation statements)

References 27 publications

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“…Signs and symptoms of chromium deficiency include glucose intolerance refractory to insulin, hyperlipidemia, elevated plasma free fatty acids, weight loss, peripheral neuropathy, and encephalopathy [21,23]. Patients receiving PN not supplemented with chromium have been found to have chromium deficiency after glucose intolerance developed [21].…”

Section: Trace Elementsmentioning

confidence: 99%

Trace Elements in Parenteral Nutrition: Considerations for the Prescribing Clinician

2017

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Trace elements (TEs) are an essential component of parenteral nutrition (PN). Over the last few decades, there has been increased experience with PN, and with this knowledge more information about the management of trace elements has become available. There is increasing awareness of the effects of deficiencies and toxicities of certain trace elements. Despite this heightened awareness, much is still unknown in terms of trace element monitoring, the accuracy of different assays, and current TE contamination of solutions. The supplementation of TEs is a complex and important part of the PN prescription. Understanding the role of different disease states and the need for reduced or increased doses is essential. Given the heterogeneity of the PN patients, supplementation should be individualized.

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Section: Trace Elementsmentioning

confidence: 99%

Trace Elements in Parenteral Nutrition: Considerations for the Prescribing Clinician

2017

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“…An inappropriate substitution may result in inadvertent complications or compromised PN compatibility. Guidelines for managing specific PN product shortages are available that provide alternative plan considerations (see Table ) . Use of an oral nutrient supplement is often recommended as an alternative to an injectable form that is unavailable.…”

Section: Home Infusion Challengesmentioning

confidence: 99%

Challenges and Obstacles of Long‐Term Home Parenteral Nutrition

Kumpf

2019

Nut in Clin Prac

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Patients receiving long‐term home parenteral nutrition (HPN) and clinicians managing their care face complex challenges not fully addressed by existing clinical practice guidelines. This review aims to increase awareness of some of the challenges encountered when managing patients receiving HPN and provide strategies for management. The ability to optimally manage these patients starts with involvement of a qualified team of clinicians, which is sometimes difficult to find. There are unique challenges related to the parenteral nutrition (PN) prescribing and compounding process that are not typically encountered with inpatient use. Clear communication is required between the HPN prescriber/team and the home infusion pharmacist to prevent errors related to misinterpretation of the order and PN product shortages. Dependency on HPN and living with chronic disease create a number of psychosocial, financial, and other lifestyle restrictions that can negatively impact a patient's quality of life. HPN nonadherence is a challenge that complicates the clinician's ability to accurately assess and make appropriate adjustments to therapy. HPN adherence may be improved by incorporating a patient‐centered approach to care that allows patients to prioritize those issues most meaningful and valuable to them. Patient‐centered care also encourages self‐care and relies on a high level of HPN education. Clinicians are encouraged to use an interactive interview style when engaging patients to prioritize goals of care and make self‐motivated decisions for change. In spite of challenges, HPN therapy has allowed patients the ability to maintain adequate nutrition and thrive in the home setting when the oral/enteral route fails.

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“…ASPEN provides strategies for managing shortages of individual PN components, including amino acids, lipid injectable emulsion, electrolytes and minerals, trace elements, vitamins, and L‐cysteine. Each shortage management consideration provides recommendations specific to the individual PN component as well as general strategies for managing shortages of PN components . The 2014 ASPEN Parenteral Nutrition Safety Consensus Recommendations include guidance for every step of the PN use process to improve the safety of PN therapy during shortages of PN components.…”

Section: Strategies and Resources For Managing Drug Shortagesmentioning

confidence: 99%

“…Each shortage management consideration provides recommendations specific to the individual PN component as well as general strategies for managing shortages of PN components. [29][30][31][32][33][34] The 2014 ASPEN Parenteral Nutrition Safety Consensus Recommendations include guidance for every step of the PN use process to improve the safety of PN therapy during shortages of PN components. 35 The final phase is the contingency plan and includes guidelines for managing a complete outage of a drug or if the drug is only available from compounding pharmacies or nontraditional sources such as the gray market or from a foreign manufacturing source.…”

Section: Strategies and Resources For Managing Drug Shortagesmentioning

confidence: 99%

Drug Shortages: Effect on Parenteral Nutrition Therapy

2018

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Drug shortages continue to be a threat to the health and welfare of numerous patients in the United States. For patients who depend on parenteral nutrition (PN) for survival, these shortages pose an even greater threat. Almost 75% of active drug shortages are sterile injectables, which includes PN components. Providing PN therapy is particularly challenging for clinicians because this is a complex medication and may contain 40 or more individual ingredients, of which multiple components may simultaneously be in limited supply. The availability of PN components must be considered during every step of the PN use process from ordering the PN prescription to administering this therapy to a patient. Alterations to a standardized process can lead to medication errors that can adversely affect patient outcomes and consume healthcare resources. (Nutr Clin Pract. 2018;33:53-61)

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Parenteral Nutrition Trace Element Product Shortage Considerations

Cited by 22 publications

References 27 publications

Trace Elements in Parenteral Nutrition: Considerations for the Prescribing Clinician

Trace Elements in Parenteral Nutrition: Considerations for the Prescribing Clinician

Challenges and Obstacles of Long‐Term Home Parenteral Nutrition

Drug Shortages: Effect on Parenteral Nutrition Therapy

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