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Perrier Q, Hosni A, Leenhardt J, Desruet MD, Durand M, Bedouch P. Automation of parenteral nutrition: impact on process and cost analysis. Eur J Hosp Pharm 2024; 31:468-473. [PMID: 37068926 DOI: 10.1136/ejhpharm-2022-003602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES On the basis of its safety and accuracy, automation is recommended for parenteral nutrition (PN). The aim of this study was to highlight the changes in practices related to the automation of PN and to perform a cost study comparing manual vs automated production costs. METHODS We conducted a micro-costing study using 1 year of manual production data for adult, neonatal and paediatric PN bagsat a hospital. We used the data to estimate the costs of automating the production process for adult, neonatal and paediatric bags. RESULTS Major modification to the PN production process resulted in: rationalisation of raw materials, computerisation and optimisation of human needs. Switching from a manual to an automated process reduced the cost of neonatal/paediatric custom bags (€130.73 vs €124.58) and semi-custom bags (€172.08 vs €166.86); but increased the cost of adult bags (€93.06 vs €127.92). CONCLUSIONS The changes resulting from the automation and revision of the production process globally increased annual expenditures by approximately 9.7%. However, automation minimised the risk of misproduction, bag contamination, and led to a more secure production process that reduced risks incurred by the teams. In view of the gain in patient and staff safety (linked to the use of an automated compounding device) the moderate economic impact (<10%) should not deter the automation of PN production circuits.
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Affiliation(s)
- Quentin Perrier
- Univ. Grenoble Alpes, LBFA, INSERM, U1055, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Amor Hosni
- Univ. Grenoble Alpes, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Leenhardt
- Univ. Grenoble Alpes, LRB, INSERM, U1039, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Marjorie Durand
- Univ. Grenoble Alpes, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierrick Bedouch
- Univ. Grenoble Alpes, TIMC, CNRS, UMR5525, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
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2
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Muacevic A, Adler JR, Konanur Srinivasa NK, Gande A, Anusha M, Dar H. Nutrition Care in Cancer Surgery Patients: A Narrative Review of Nutritional Screening and Assessment Methods and Nutritional Considerations. Cureus 2022; 14:e33094. [PMID: 36721576 PMCID: PMC9884126 DOI: 10.7759/cureus.33094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Abstract
Malignancy is a catabolic state, which is precipitated with surgical intervention. Malnutrition is one of the main risk factors for poor outcomes of cancer surgery. We need to screen oncological patients for malnutrition using standardized screening tools, by which patients found to be at nutritional risk are then referred to a registered dietitian for further management. A detailed assessment is required in such patients, which helps in categorizing the patients based on the severity and rendering proper care. Preoperative nutrition care is often overlooked because of the urgency of operating on a cancer patient. Still, studies have shown preoperative nutritional building gives better surgical outcomes and good postoperative quality of life. Preoperative nutrition care includes both early and late preoperative care. For efficient preoperative nutrition care publishing, standard operating procedures at every healthcare center are recommended. Postoperative nutrition care is given to build the patient tackle the surgical trauma, and their diet mainly includes protein to minimize catabolism. Regardless of the route of nutrition delivery, providing appropriate nutrition care in the postoperative period improves cancer patients' condition drastically. Early postoperative nutrition is studied in different cancer surgeries and is considered ideal in cancer surgical patients. There is a need for consensus on the composition of postoperative nutrition. The diet of a cancer patient should include micronutrients like vitamins D and B and minerals along with the usual nutrition care. The use of special diets like branched-chain amino acids and immune nutrition is to be considered on a case-by-case basis and introducing them into the routine care of a patient needs to be studied extensively.
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Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale RG, Waitzberg D, Bischoff SC, Singer P. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40:4745-4761. [PMID: 34242915 DOI: 10.1016/j.clnu.2021.03.031] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover both nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include the integration of nutrition into the overall management of the patient, avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, the start of nutritional therapy immediately if a nutritional risk becomes apparent, metabolic control e.g. of blood glucose, reduction of factors which exacerbate stress-related catabolism or impaired gastrointestinal function, minimized time on paralytic agents for ventilator management in the postoperative period, and early mobilization to facilitate protein synthesis and muscle function.
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Affiliation(s)
- Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany.
| | - Marco Braga
- University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Franco Carli
- Department of Anesthesia of McGill University, School of Nutrition, Montreal General Hospital, Montreal, Canada
| | | | - Martin Hübner
- Service de chirurgie viscérale, Centre Hospitalier Universitaire de Lausanne, Lausanne, Switzerland
| | - Stanislaw Klek
- General Surgical Oncology Clinic, National Cancer Institute, Krakow, Poland
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | | | - Dan Waitzberg
- University of Sao Paulo Medical School, Ganep, Human Nutrition, Sao Paulo, Brazil
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | - Pierre Singer
- Institute for Nutrition Research, Rabin Medical Center, Beilison Hospital, Petah Tikva, Israel
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4
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Cogle SV, Martindale RG, Ramos M, Roberti GJ, Roberts PR, Taylor K, Sacks GS. Multicenter Prospective Evaluation of Parenteral Nutrition Preparation Time and Resource Utilization: 3-Chamber Bags Compared With Hospital Pharmacy-Compounded Bags. JPEN J Parenter Enteral Nutr 2020; 45:1552-1558. [PMID: 33188572 DOI: 10.1002/jpen.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/16/2020] [Accepted: 11/06/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) is a complex and costly therapy that places significant demands on healthcare resources. Commercially manufactured 3-chamber bags (3CBs) offer potential time and cost advantages compared with hospital pharmacy-compounded bags (HCBs); however, no data are yet available from studies comparing these delivery systems in US hospitals. The primary aim of this study was to evaluate the PN preparation time and resource utilization required for 3CBs compared with HCBs in US hospitals. METHODS A prospective, multicenter, time and motion study was performed to evaluate the time from transcription to completion of PN preparation and costs for 3CBs compared with HCBs. The cost per bag included labor, PN products, medical consumables, and equipment. RESULTS One hundred thirty-six PN prescriptions were prepared during the study (66 prescriptions for 3CBs and 70 prescriptions for HCBs). The mean ± standard deviation total time required for transcription, review, validation, and preparation of PN was 5.5 ± 1.3 minutes for 3CBs vs 14.3 ± 6.2 minutes for HCBs (P < .001). The mean total cost per PN bag was $81.60 for 3CBs and $131.17 for HCBs (mean difference, -$49.57). CONCLUSION Commercial 3CBs reduced staff time by 62% and direct costs by 37% compared with HCBs. The results demonstrate that 3CBs offer potential cost-savings for hospitalized patients who require PN in US hospitals.
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Affiliation(s)
- Sarah V Cogle
- Department of Pharmacy Practice, Auburn University, Auburn, Alabama, USA.,Department of Pharmacy, East Alabama Medical Center, Opelika, Alabama, USA
| | - Robert G Martindale
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Gregory J Roberti
- Department of Pharmacy, Oregon Health and Science University, Portland, Oregon, USA
| | - Pamela R Roberts
- Department of Anesthesiology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Kaci Taylor
- Department of Pharmacy, OU Medical Center, Oklahoma City, Oklahoma, USA
| | - Gordon S Sacks
- Department of Pharmacy Practice, Auburn University, Auburn, Alabama, USA.,Medical Affairs, Fresenius Kabi, LLC, Lake Zurich, Illinois, USA
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5
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Berlana D, Almendral MA, Abad MR, Fernández A, Torralba A, Cervera‐Peris M, Piñeiro G, Romero‐Jiménez R, Vázquez A, Ramírez E, Yébenes M, Muñoz Á. Cost, Time, and Error Assessment During Preparation of Parenteral Nutrition: Multichamber Bags Versus Hospital‐Compounded Bags. JPEN J Parenter Enteral Nutr 2018; 43:557-565. [DOI: 10.1002/jpen.1436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/02/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Affiliation(s)
- David Berlana
- Vall d´Hebron Barcelona Hospital Campus Barcelona Spain
| | | | | | | | | | | | | | | | - Amparo Vázquez
- La Fe University and Politechnic Hospital Valencia Spain
| | | | - María Yébenes
- Pharmacoeconomics & Outcomes‐Research‐Iberia Pozuelo de Alarcón Spain
| | - Álvaro Muñoz
- Pharmacoeconomics & Outcomes‐Research‐Iberia Pozuelo de Alarcón Spain
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6
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Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale R, Waitzberg DL, Bischoff SC, Singer P. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr 2017; 36:623-650. [DOI: 10.1016/j.clnu.2017.02.013] [Citation(s) in RCA: 966] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
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7
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Nzamushe JR, Sozanski JP, De Jonckheere J, Jeanne M, Logier R. Optimization of extra corporeal enteral prosthesis (ECEP) by selective aspiration of the digestive flow. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:545-548. [PMID: 28268389 DOI: 10.1109/embc.2016.7590760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Reinfusion is a medical process which collects digestive flow from a proximal stoma to a distal one, in patient who had a post-operative double enteral stoma. This process avoids the risk of under nutrition and frees the patient from a Total Parenteral Nutrition to offset the digestive loss. Most of the previous ways of reinfusion first collect the digestive flow into a bag before instillation. We developed an ambulatory reinfusion pump (ECEP) which had the advantage to collect the digestive flow directly from the proximal stoma and to pump it to the distal one. However, the main risk of such a continuous pumping process is to create mucosae lesions by direct suction. The aim of this study is to up-grade our device by introducing a selective aspiration based on the arrival of digestive flow.
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8
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Alfonso JE, Berlana D, Ukleja A, Boullata J. Clinical, Ergonomic, and Economic Outcomes With Multichamber Bags Compared With (Hospital) Pharmacy Compounded Bags and Multibottle Systems: A Systematic Literature Review. JPEN J Parenter Enteral Nutr 2016; 41:1162-1177. [DOI: 10.1177/0148607116657541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Andrew Ukleja
- Gastroenterology, Cleveland Clinic, Weston, Florida, USA
| | - Joseph Boullata
- Hospital of the University of Pennsylvania, and Drexel University, Philadelphia, Pennsylvania, USA
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9
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Nzamushe JR, Sozanski JP, De Jonckheere J, Jeanne M, Logier R. Performance evaluation of the extra corporeal enteral prosthesis (ECEP) vs a By-Pass. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:4793-6. [PMID: 26737366 DOI: 10.1109/embc.2015.7319466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intestinal stoma constitutes a symptomatic treatment in a wide range of digestive diseases, such as rectal cancer, digestive traumatic perforation and inflammatory intestinal diseases. It affects a patient's life causing physiologic and social constraints. The stoma can lead to involution of the downstream digestive tissue, impairing his function in case of restored continuity. Some technical solutions have been developed in order to maintain intestinal continuity, reduce inflammatory risk and to increase patient's quality of life. In this paper, we describe a smart intestinal prosthesis equipped with a pump working as an intestinal segment and creating a bypass between the upstream and downstream intestinal sides. We also evaluate the performance the digestive prosthesis ECEP vs a simple digestive By-Pass.
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10
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Jia ZY, Yang J, Xia Y, Tong DN, Zaloga GP, Qin HL. Safety and efficacy of an olive oil-based triple-chamber bag for parenteral nutrition: a prospective, randomized, multi-center clinical trial in China. Nutr J 2015; 14:119. [PMID: 26574019 PMCID: PMC4647821 DOI: 10.1186/s12937-015-0100-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/12/2015] [Indexed: 12/15/2022] Open
Abstract
Background Small studies suggest differences in efficacy and safety exist between olive oil-based (OLIVE) and soybean oil-based (SOYBEAN) parenteral nutrition regimens in hospitalized adult patients. This large, prospective, randomized (1:1), open-label, multi-center, noninferiority study compared the delivery, efficacy, and safety of OLIVE (N = 226) with SOYBEAN (N = 232) in Chinese adults (≥18 years) admitted to a surgical service for whom parenteral nutrition was required. Methods Treatments were administered for a minimum of 5 days up to 14 days (to achieve approximately 25 kcal/kg/day, 0.9 g/kg/day amino acids, 0.8 g/kg/day lipid). Impact of treatment on anabolic/catabolic and serum inflammatory, chemistry, and hematological markers, safety, and ease of use were assessed. The primary efficacy variable was serum prealbumin level at Day 5. Results OLIVE (n = 219) was not inferior to SOYBEAN (n = 224) based on the prealbumin least square geometric mean [LSGM] ratio [95 % CI] 1.12 [1.06, 1.19]; P = 0.002), improved the anabolic/catabolic status of patients enrolled in the study, and was well tolerated compared with SOYBEAN. Improved anabolic status was supported by significantly higher levels of prealbumin at Day 5, albumin at Day 5 and IGF-1 at Day 14 in the OLIVE group, while catabolism was similar between groups. C-reactive protein, intercellular adhesion molecule-1, procalcitonin, and oxidation were similar in each group, but infections were significantly lower with OLIVE (3.6 % versus 10.4 %; P < 0.01). Conclusions OLIVE provided effective nutrition, was well tolerated, was associated with fewer infections, and conferred greater ease-of-use than SOYBEAN. Trial registration NTC 01579097.
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Affiliation(s)
- Zhen-Yi Jia
- Department of Surgery, Shanghai Sixth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, China.
| | - Jun Yang
- Department of Surgery, Shanghai Sixth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, China.
| | - Yang Xia
- Department of Surgery, Shanghai Sixth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, China.
| | - Da-Nian Tong
- Department of Surgery, Shanghai Sixth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, China.
| | | | - Huan-Long Qin
- Department of Surgery, Shanghai Sixth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, China. .,General Surgery, Shanghai Tenth People's Hospital (Tenth People'sHospital of Tongii University), Shanghai, 200072, China.
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11
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Chhim RF, Crill CM. Premixed Parenteral Nutrition Solution Use in Children. J Pediatr Pharmacol Ther 2015; 20:378-84. [DOI: 10.5863/1551-6776-20.5.378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES: In response to national drug shortages, our institution established criteria for the use of commercial premixed parenteral nutrition (PN) solutions in select pediatric patients. Although these solutions have been marketed for use in children, there are no data in this patient population. The objective of this study was to review our use of commercial premixed PN solutions in children.
METHODS: This was a retrospective review of patients ≤18 years of age who received a premixed PN solution from October 2010 to April 2012. All premixed PN courses were assessed for incidence of premixed PN discontinuation due to laboratory abnormalities. Estimated goal and actual protein and total caloric intake were evaluated for premixed PN courses that were continued for >48 hours.
RESULTS: Sixty-nine patients received 74 courses of premixed PN solutions for a mean duration of 5.6 ± 6.2 (range, 1–31) days. Fifteen courses (20%) required discontinuation of premixed PN as a result of mild laboratory abnormalities. No changes in clinical status were observed in patients and all abnormalities were corrected after switching to individualized PN. In patients receiving PN for >48 hours, premixed PN solutions provided goal protein in 48/49 (98%) courses and goal calories in 33/49 (67%) courses.
CONCLUSIONS: Premixed PN solutions were used in a wide range of pediatric patients and provide a potential option for PN support in pediatric patients when drug shortages limit PN product supply. Close monitoring for electrolyte abnormalities and protein and caloric intake is recommended when using premixed PN solutions in children.
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Affiliation(s)
- Rebecca F. Chhim
- Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine M. Crill
- Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
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12
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Ferguson T, Emery S, Price-Davies R, Cosslett A. A review of stability issues associated with vitamins in parenteral nutrition. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.clnme.2014.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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The impact of parenteral nutrition preparation on bloodstream infection risk and costs. Eur J Clin Nutr 2014; 68:953-8. [DOI: 10.1038/ejcn.2014.34] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 01/14/2014] [Accepted: 01/31/2014] [Indexed: 11/08/2022]
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14
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Bozat E, Korubuk G, Onar P, Abbasoglu O. Cost analysis of premixed multichamber bags versus compounded parenteral nutrition: breakeven point. Hosp Pharm 2014; 49:170-6. [PMID: 24623870 PMCID: PMC3940682 DOI: 10.1310/hpj4902-170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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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Affiliation(s)
- Erkut Bozat
- Institute of Social Sciences, İstanbul Bilgi University, Istanbul, Turkey
- Eczacibasi-Baxter, Istanbul, Turkey
| | - Gamze Korubuk
- Hospital Pharmacy, Hacettepe University Teaching Hospital, Ankara, Turkey
| | - Pelin Onar
- Nutrition Support Team, Hacettepe University Teaching Hospital, Ankara, Turkey
| | - Osman Abbasoglu
- Department of General Surgery, Hacettepe University Teaching Hospital, Ankara, Turkey
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15
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Koller M, Schütz T, Valentini L, Kopp I, Pichard C, Lochs H. Outcome models in clinical studies: Implications for designing and evaluating trials in clinical nutrition. Clin Nutr 2013; 32:650-7. [DOI: 10.1016/j.clnu.2012.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 07/20/2012] [Accepted: 08/07/2012] [Indexed: 12/20/2022]
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16
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Pontes-Arruda A, Dos Santos MCFC, Martins LF, González ERR, Kliger RG, Maia M, Magnan GB. Influence of parenteral nutrition delivery system on the development of bloodstream infections in critically ill patients: an international, multicenter, prospective, open-label, controlled study--EPICOS study. JPEN J Parenter Enteral Nutr 2012; 36:574-86. [PMID: 22269899 DOI: 10.1177/0148607111427040] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) is associated with an increased risk of developing bloodstream infections (BSIs) but the impact of the PN delivery system upon BSI rates remains unclear. This was an international, multicenter, prospective, randomized, open-label, controlled trial that investigated the differences of BSIs associated with 2 different PN systems. METHODS Patients were randomly allocated in a 2:1:1 ratio to receive either PN delivered by a multichamber bag (MCB group), or by compounded PN made with olive oil (COM1 group) or with MCT/LCT (COM2 group). Blood cultures were performed to evaluate the incidence of BSIs, and catheter use data was collected to calculate CLAB and central venous catheter device use ratio (CVC-DUR). Secondary outcomes included the development of severe sepsis/septic shock, number of intensive care unit (ICU) and hospital days, and all-cause mortality at Day 28. RESULTS 406 patients were included: 202 in the MCB group, 103 in the COM1 group, and 101 in the COM2 group. Baseline characteristics were well balanced between the 3 groups, BSIs were significantly higher in patients receiving compounded PN (46 BSIs for COM1+COM2 vs 34 BSIs for MCB; p = 0.03).CLAB was higher in patients receiving compounded PN (13.2 for COM1+COM2 vs 10.3 for MCB; p < 0.0001). No differences were observed for the secondary outcomes. CONCLUSION Compounded PN was associated with a higher incidence of BSIs and CLABs, suggesting that the use of MCB PN may play a role in reducing the incidence of BSIs in patients who receive PN. TRIAL REGISTRATION NUMBER NCT00798681.
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17
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Walter E, Liu FX, Maton P, Storme T, Perrinet M, von Delft O, Puntis J, Hartigan D, Dragosits A, Sondhi S. Cost analysis of neonatal and pediatric parenteral nutrition in Europe: a multi-country study. Eur J Clin Nutr 2012; 66:639-44. [PMID: 22252109 DOI: 10.1038/ejcn.2011.225] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Parenteral nutrition (PN) is critical in neonatal and pediatric care for patients unable to tolerate enteral feeding. This study assessed the total costs of compounding PN therapy for neonates, infants and children. METHODS Face-to-face and telephone interviews were conducted in 12 hospitals across four European countries (Belgium, France, Germany and UK) to collect information on resources utilized to compound PN, including nutrients, staff time, equipment cost and supplies. A bottom-up cost model was constructed to assess total costs of PN therapy by assigning monetary values to the resource utilization using published list prices and interview data. RESULTS A total of 49,922 PN bags per year were used to treat 4295 neonatal and pediatric patients among these hospitals. The daily total costs of one compounded PN bag for neonates in the 12 hospitals across the four countries equalled euro 55.16 (Belgium euro 53.26, France euro 46.23, Germany euro 64.05, UK Ł 37.43/\[euro]42.86). Overall, nutrients accounted for 25% of total costs, supplies 18%, wages 54% and equipment 3%. Average costs per bag for infants <2 year were euro 84.52 (euro 74.65 in Belgium, euro 83.84 in France, euro 92.70 in Germany and Ł 52.63/euro 60.26 in the UK), and for children 2-18 years euro 118.02 (euro 93.85 in Belgium, euro 121.35 in France, euro 124.54 in Germany and Ł 69.49/euro 79.56 in the UK), of which 63% is attributable to nutrients and 28% to wages. CONCLUSION The data indicated that PN costs differ among countries and a major proportion was due to staff time (Ł 1=euro 1.144959).
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Affiliation(s)
- E Walter
- Institute for Pharmacoeconomic Research, Vienna, Austria.
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18
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Miller SJ. Commercial Premixed Parenteral Nutrition: Is It Right for Your Institution? Nutr Clin Pract 2009; 24:459-69. [DOI: 10.1177/0884533609339067] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sarah J. Miller
- From the University of Montana, Saint Patrick Hospital, Skaggs School of Pharmacy, Missoula, Montana
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