Peripheral venous nutrition: the equal relevance of volume load and osmolarity in relation to phlebitis

Timmer, J.; Schipper, H.G.

doi:10.1016/0261-5614(91)90090-y

Cited by 47 publications

(31 citation statements)

References 8 publications

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“…Other factors that may influence the incidence of thrombophlebitis include addition of heparin, 31,32 addition of corticosteroid, 31 or the presence of fat emulsion when PPN is prepared as a TNA. [32][33][34][35] The coinfusion of intravenous fat emulsion (IVFE) has not been shown to reduce phlebitis. 36,37 All available studies that have evaluated peripheral vein thrombophlebitis with infusion of PPN are limited by small sample size.…”

Section: Strongmentioning

confidence: 99%

“…Osmolarity rates <100 mOsm/h improve patient tolerance. 33 There is no consensus on what is considered a "tolerable" rate of thrombophlebitis or an acceptable duration of infusion before phlebitis occurs. Kane et al 35 accepted a thrombophlebitis rate of 30% and found that peripheral intravenous (IV) cannulas remained patent for an average of 6.3 days in patients receiving a high osmolarity (1700 mOsm/L) PPN.…”

Section: Strongmentioning

confidence: 99%

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

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

253

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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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Section: Strongmentioning

confidence: 99%

Section: Strongmentioning

confidence: 99%

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

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

253

View full text Add to dashboard Cite

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“…Only admixtures with a maximum osmolarity of 900 mOsm/ L can be administered via a peripheral vein and only for a limited period of time [69]. Long term parenteral nutrition can be also administered via a port (see Sect.…”

Section: Administration Of Parenteral Nutrition Admixturesmentioning

confidence: 99%

Parenteral

Tubic-Grozdanis¹,

Krämer²

2015

Practical Pharmaceutics

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“…2 It appears possible to replenish consumed energy via peripheral veins, 3 often using a mixture of a hypertonic glucose solution and an amino acid solution for TPN: however, peripheral phlebitis or thrombosis sometimes occurs when they are used for PPN. [4][5][6][7][8] Our study on the composition of IV solutions revealed that solutions composed of a mixture of fat, amino acids, and glucose are nutritionally superior to solutions composed of a mixture of fat and amino acids or a mixture of glucose and amino acids. 9 Because PPN shows promise as a means of providing postoperative nutritional replenishment, we evaluated the nutritional profiles of IV solutions composed of different ratios of fat, amino acids, and glucose.…”

Section: Introductionmentioning

confidence: 99%

Clinical study on the ratio of glucose/fat in peripheral parenteral nutrition and the usage of a midline catheter

1999

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Two important unsolved questions related to peripheral parenteral nutrition are the ratio of components in the intravenous (IV) solution and catheter-related complications. The present study was undertaken to evaluate the nutritional profiles of three kinds of IV solutions with different ratios of components, while maintaining the total energy at about 1 200 kcal/day and the amino acid level at 60 g. The IV solution formulas used were as follows : glucose/fat = 2:1, osmolarity ratio = 3.3 for group A, glucose/fat = 1:1, osmolarity ratio = 3.1 for group B, and glucose/fat = 1:2, osmolarity ratio = 2.6 for group C. The incidence and severity of complications were then analyzed in relation to the type of IV solution used, the indwelling time, and the type of catheter (midline catheter or short peripheral catheter). The results of peripheral parenteral nutrition were favorable when the glucose/fat ratio of the IV solution was either 1:1 or 1:2. The midline catheter was inserted for an average of 11.9 +/- 4.0 days, and the incidence of catheter-related complications following parenteral nutrition with a midline catheter was low when the osmolarity ratio of the IV solution was 3.1 or less. These results indicate that a midline catheter is useful when administering peripheral parenteral nutrition.

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Peripheral venous nutrition: the equal relevance of volume load and osmolarity in relation to phlebitis

Cited by 47 publications

References 8 publications

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

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

Parenteral

Clinical study on the ratio of glucose/fat in peripheral parenteral nutrition and the usage of a midline catheter

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