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Hardy G, Austin PD, Davis MR, Manzanares W, Mühlebach SF, Pietka M, Allwood MC. Photoprotection of parenteral nutrition: an international perspective. Nutr Clin Pract 2021; 36:921-925. [PMID: 34494687 DOI: 10.1002/ncp.10773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | - Peter D Austin
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust and University College, London, UK
| | | | - William Manzanares
- Department of Critical Care, University Hospital, Faculty of Medicine, Universidad de la República UdelaR, Uruguay
| | - Stefan F Mühlebach
- Department of Pharmaceutical Sciences, Division of Clinical Pharmacy & Epidemiology/Hospital Pharmacy, University of Basel, Switzerland
| | - Magdalena Pietka
- Pharmacy Department, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Michael C Allwood
- Biopharma Stability Testing Laboratory, BioCity Nottingham, Nottingham, UK
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Pironi L, Arends J, Bozzetti F, Cuerda C, Gillanders L, Jeppesen PB, Joly F, Kelly D, Lal S, Staun M, Szczepanek K, Van Gossum A, Wanten G, Schneider SM. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016; 35:247-307. [PMID: 26944585 DOI: 10.1016/j.clnu.2016.01.020] [Citation(s) in RCA: 457] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Chronic Intestinal Failure (CIF) is the long-lasting reduction of gut function, below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. CIF is the rarest organ failure. Home parenteral nutrition (HPN) is the primary treatment for CIF. No guidelines (GLs) have been developed that address the global management of CIF. These GLs have been devised to generate comprehensive recommendations for safe and effective management of adult patients with CIF. METHODS The GLs were developed by the Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds, and accepted in an online survey of ESPEN members. RESULTS The following topics were addressed: management of HPN; parenteral nutrition formulation; intestinal rehabilitation, medical therapies, and non-transplant surgery, for short bowel syndrome, chronic intestinal pseudo-obstruction, and radiation enteritis; intestinal transplantation; prevention/treatment of CVC-related infection, CVC-related occlusion/thrombosis; intestinal failure-associated liver disease, gallbladder sludge and stones, renal failure and metabolic bone disease. Literature search provided 623 full papers. Only 12% were controlled studies or meta-analyses. A total of 112 recommendations are given: grade of evidence, very low for 51%, low for 39%, moderate for 8%, and high for 2%; strength of recommendation: strong for 63%, weak for 37%. CONCLUSIONS CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for both the underlying gastrointestinal disease and to provide HPN support. The rarity of the condition impairs the development of RCTs. As a consequence, most of the recommendations have a low or very low grade of evidence. However, two-thirds of the recommendations are considered strong. Specialized management and organization underpin these recommendations.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | | | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Lyn Gillanders
- Nutrition Support Team, Auckland City Hospital, (AuSPEN) Auckland, New Zealand
| | | | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Darlene Kelly
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA; Oley Foundation for Home Parenteral and Enteral Nutrition, Albany, NY, USA
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - Michael Staun
- Rigshospitalet, Department of Gastroenterology, Copenhagen, Denmark
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - André Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Stéphane Michel Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France
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Pharmaceutical point of view on parenteral nutrition. ScientificWorldJournal 2013; 2013:415310. [PMID: 24453847 PMCID: PMC3885274 DOI: 10.1155/2013/415310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/06/2013] [Indexed: 11/17/2022] Open
Abstract
Parenteral nutrition--a form of administering nutrients, electrolytes, trace elements, vitamins, and water--is a widely used mode of therapy applied in many diseases, in patients of different ages both at home and in hospital. The success of nutritional therapy depends chiefly on proper determination of the patient's energetic and electrolytic needs as well as preparation and administration of a safe nutritional mixture. As a parenterally administered drug, it is expected to be microbiologically and physicochemically stable, with all of the components compatible with each other. It is very difficult to obtain a stable nutritional mixture due to the fact that it is a complex, two-phase drug. Also, the risk of incompatibility between mixture components and packaging should be taken into consideration and possibly eliminated. Since parenteral nutrition is a part of therapy, simultaneous use of drugs may cause pharmacokinetic and pharmacodynamic interactions as well as those with the pharmaceutical phase. The aim of this paper is to discuss such aspects of parenteral nutrition as mixture stability, methodology, and methods for determining the stability of nutritional mixtures and drugs added to them.
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Dibb M, Teubner A, Theis V, Shaffer J, Lal S. Review article: the management of long-term parenteral nutrition. Aliment Pharmacol Ther 2013; 37:587-603. [PMID: 23331163 DOI: 10.1111/apt.12209] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/08/2012] [Accepted: 12/21/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure. AIM To summarise the major issues in delivering long-term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure. METHODS A literature search using PubMed and MEDLINE databases was performed. RESULTS Safe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter-associated blood stream infection (reported incidence 0.14-0.83 episodes/patient-year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient-year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19-75%) and advanced liver disease (0-50%). Five-year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long-term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults. CONCLUSIONS Home parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter-related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.
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Affiliation(s)
- M Dibb
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK.
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Lobo BW, da Veiga VF, Cabral LM, Michel RC, Volpato NM, de Sousa VP. Influence of the relative composition of trace elements and vitamins in physicochemical stability of total parenteral nutrition formulations for neonatal use. Nutr J 2012; 11:26. [PMID: 22510447 PMCID: PMC3411489 DOI: 10.1186/1475-2891-11-26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 04/17/2012] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate the influence of the relative composition of trace elements and vitamins in physicochemical stability of neonatal parenteral nutrition. MATERIAL AND METHODS Three formulations for neonatal administration were selected; the main variable was the presence of trace elements and vitamins. The analyses where carried out immediately after preparation and at 24 h, 48 h, 72 h and 7 days after preparation. Three methods were selected to determine globule size: light obscuration, dynamic light scattering and optical microscopy. Complementary evaluation including visual inspection, determination of pH and osmolarity, peroxide levels and measurements of zeta potential were also performed. RESULTS There was an observable alteration in color and phase separation in the PN stored at 25°C and 40°C. Neither globule size pattern, nor any other physicochemical characteristic evaluated appeared to be considerably altered in any of the analyzed formulations even after 7 days of storage at 5°C. Globule size in all the PN studied was consistent with the established limit, below 500 nm by DLS measurement, and PFAT5 was below 0.05% under all storage temperatures. CONCLUSION Concomitant presence of trace elements and vitamins in the same neonatal formulation did not alter the evaluated aspects of stability.
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Affiliation(s)
- Bianca W Lobo
- Departamento de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brasil
| | - Venício F da Veiga
- Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brasil
| | - Lúcio M Cabral
- Departamento de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brasil
| | - Ricardo C Michel
- Instituto de Macromoléculas Professora Eloisa Mano, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21945-970, Brasil
| | - Nádia M Volpato
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90610-000, Brasil
| | - Valéria P de Sousa
- Departamento de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brasil
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Ribeiro DO, Pinto DC, Lima LMTR, Volpato NM, Cabral LM, de Sousa VP. Chemical stability study of vitamins thiamine, riboflavin, pyridoxine and ascorbic acid in parenteral nutrition for neonatal use. Nutr J 2011; 10:47. [PMID: 21569609 PMCID: PMC3115844 DOI: 10.1186/1475-2891-10-47] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 05/14/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of this work was to study the vitamins B1, B2, B6 and C stability in a pediatric formulation containing high amounts of calcium in the presence of organic phosphate, amino acids, glucose, sodium chloride, magnesium sulfate, pediatric vitamins and trace elements under different conditions using developed and validated analytical methods. METHODS The study was carried out during 72 h with formulations packaged in recommended storage temperature (4°C) and 25°C, with and without photoprotection. RESULTS The results showed that the methodologies used for assessing the chemical stability of vitamins B1, B2, B6 and C in the formulation were selective, linear, precise and accurate. The vitamins could be considered stable in the formulation during the three days of study if stored at 4°C. When stored at 25°C vitamin C presented instability after 48 h. CONCLUSION The pediatric formulation containing high amount of calcium in the presence of organic phosphate, amino acids, glucose, sodium chloride, magnesium sulphate, pediatric vitamins and trace elements packaged in bag-type trilaminate presented a shelf life of the 72 h, when maintained under refrigeration, between 2°C and 8°C. This shelf life was measured considering the vitamins studied. Further studies are needed including all the vitamins present in this formulation.
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Affiliation(s)
- Daniela O Ribeiro
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
| | - Daniela C Pinto
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
| | - Luis Mauricio TR Lima
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
| | - Nádia M Volpato
- Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS 90610-000, Brazil
| | - Lúcio M Cabral
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
| | - Valéria P de Sousa
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
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Bouchoud L, Sadeghipour F, Klingmüller M, Fonzo-Christe C, Bonnabry P. Long-term physico-chemical stability of standard parenteral nutritions for neonates. Clin Nutr 2010; 29:808-12. [DOI: 10.1016/j.clnu.2010.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
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Ribeiro DDO, Lobo BW, Volpato NM, da Veiga VF, Cabral LM, de Sousa VP. Influence of the calcium concentration in the presence of organic phosphorus on the physicochemical compatibility and stability of all-in-one admixtures for neonatal use. Nutr J 2009; 8:51. [PMID: 19857269 PMCID: PMC2772853 DOI: 10.1186/1475-2891-8-51] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 10/26/2009] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Preterm infants need high amounts of calcium and phosphorus for bone mineralization, which is difficult to obtain with parenteral feeding due to the low solubility of these salts. The objective of this study was to evaluate the physicochemical compatibility of high concentrations of calcium associated with organic phosphate and its influence on the stability of AIO admixtures for neonatal use. METHODS Three TPN admixture formulas were prepared in multilayered bags. The calcium content of the admixtures was adjusted to 0, 46.5 or 93 mg/100 ml in the presence of a fixed organic phosphate concentration as well as lipids, amino acids, inorganic salts, glucose, vitamins and oligoelements at pH 5.5. Each admixture was stored at 4 degrees C, 25 degrees C or 37 degrees C and evaluated over a period of 7 days. The physicochemical stability parameters evaluated were visual aspect, pH, sterility, osmolality, peroxide formation, precipitation, and the size of lipid globules. RESULTS Color alterations occurred from the first day on, and reversible lipid film formation from the third day of study for the admixtures stored at 25 degrees C and 37 degrees C. According to the parameters evaluated, the admixtures were stable at 4 degrees C; and none of them presented precipitated particles due to calcium/phosphate incompatibility or lipid globules larger than 5 mum, which is the main parameter currently used to evaluate lipid emulsion stability. The admixtures maintained low peroxide levels and osmolarity was appropriate for parenteral administration. CONCLUSION The total calcium and calcium/phosphorus ratios studied appeared not to influence the physicochemical compatibility and stability of AIO admixtures.
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Affiliation(s)
- Daniela de Oliveira Ribeiro
- Departamento de Medicamentos, Faculdade de Farmácia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, CCS, Bloco B ss sala 15, Rio de Janeiro, RJ 21941-902, Brazil
| | - Bianca Waruar Lobo
- Departamento de Medicamentos, Faculdade de Farmácia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, CCS, Bloco B ss sala 15, Rio de Janeiro, RJ 21941-902, Brazil
| | - Nádia Maria Volpato
- Departamento de Medicamentos, Faculdade de Farmácia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, CCS, Bloco B ss sala 15, Rio de Janeiro, RJ 21941-902, Brazil
| | - Venício Féo da Veiga
- Instituto de Microbiologia Professor Paulo de Góes, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-902, Brazil
| | - Lúcio Mendes Cabral
- Departamento de Medicamentos, Faculdade de Farmácia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, CCS, Bloco B ss sala 15, Rio de Janeiro, RJ 21941-902, Brazil
| | - Valeria Pereira de Sousa
- Departamento de Medicamentos, Faculdade de Farmácia, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, CCS, Bloco B ss sala 15, Rio de Janeiro, RJ 21941-902, Brazil
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Gonyon T, Carter PW, Dahlem O, Denet AR, Owen H, Trouilly JL. Container effects on the physicochemical properties of parenteral lipid emulsions. Nutrition 2008; 24:1182-8. [DOI: 10.1016/j.nut.2008.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 05/16/2008] [Accepted: 06/03/2008] [Indexed: 10/21/2022]
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Gillanders L, Angstmann K, Ball P, Chapman-Kiddell C, Hardy G, Hope J, Smith R, Strauss B, Russell D. AuSPEN clinical practice guideline for home parenteral nutrition patients in Australia and New Zealand. Nutrition 2008; 24:998-1012. [PMID: 18708279 DOI: 10.1016/j.nut.2008.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 06/09/2008] [Accepted: 06/09/2008] [Indexed: 10/21/2022]
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Skouroliakou M, Matthaiou C, Chiou A, Panagiotakos D, Gounaris A, Nunn T, Andrikopoulos N. Physicochemical Stability of Parenteral Nutrition Supplied as All-in-One for Neonates. JPEN J Parenter Enteral Nutr 2008; 32:201-9. [DOI: 10.1177/0148607108314768] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Maria Skouroliakou
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Chrysoula Matthaiou
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Antonia Chiou
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Demosthenes Panagiotakos
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Antonis Gounaris
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Tony Nunn
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Nikolaos Andrikopoulos
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
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Stability investigation of total parenteral nutrition admixture prepared in a hospital pharmacy. VOJNOSANIT PREGL 2008; 65:286-90. [DOI: 10.2298/vsp0804286m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. In the cases when nutrition of patients can not be orally nor enterally performed, parenteral nutrition is a method of the therapy that provides more successful and rapid recovery. In that way, hospitalization can be significantly shorter, healing costs reduced and mortality minimized. Total parenteral nutrition (TPN) admixtures are the most complex systems which contain amino acids, carbohydrates, lipid emulsion, macroelectrolytes (Na+, K+, Ca2+, Mg2+, Cl-, SO42-, PO43-), oligoelements, hydro- and liposoluble vitamines, heparin, insulin and water. Concerning the mentioned complexity, special attention should be payed to physicochemical and microbiological stability of a mixture, because of interactions among components, that can be very hard to analyze. The aim of this study was to investigate the problem of stability of TPN admixtures prepared in a hospital pharmacy. Methods. Admixture TPN was aseptically prepared in laminar air - flow environment on the basis of the specified order in supplementing components and additives to basic solutions. Solutions were kept in sterile multicompartment ethylene-vinyl-acetate bags. After preparation and slow homogenization, TPN admixtures were submitted to physicochemical and microbiological stability analyses in various period of time. The assessment of physical stability of TPN admixture was done on the basis of visual inspection, determination of pH value and measuring of particle size. The investigation of sterility and pyrogenic test were performed according to Ph. Yug. V regulations. Results. Physico-chemical and microbiological analyses were applied and no significant changes in visual sense, pH value and droplet size stability of the TPN admixture were observed during the period of 60 hours. The lipid droplets were smaller in size than 5 ?m, that is the most common pharmacopoeia requirement. Conclusion. The results of our study confirmed that a TPN admixture prepared in a hospital pharmacy can be stored without stability loss for at least 60 hours.
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Abstract
PURPOSE OF REVIEW Although there have been no fundamental changes in the nature and practice of parenteral nutrition during the review period, there have been important observations with respect to adjunctive hormonal manipulation and the recognition of new hazards that warrant review. RECENT FINDINGS Papers summarized include those demonstrating benefit from addition of growth hormone, and of medium-chain triglycerides, and those indicating that there is no apparent aggravation to osteoporosis, even with long-term intravenous nutrition. General advice is given on the place for new interventions and avoidance of complications. SUMMARY The relative safety of long-term parenteral nutrition is reconfirmed. Interesting new manipulations of the hormonal and lipid milieu may prove to be important developments.
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