A.S.P.E.N. Clinical Guidelines: Parenteral Nutrition Ordering, Order Review, Compounding, Labeling, and Dispensing. (14th February 2014)

• Record Type: Journal Article
• Authors: Boullata, Joseph I.; Gilbert, Karen; Sacks, Gordon; Labossiere, Reginald J.; Crill, Cathy; Goday, Praveen; Kumpf, Vanessa J.; Mattox, Todd W.; Plogsted, Steve; Holcombe, Beverly
• Other Names: Malone Ainsley contributionsBy.; Teitelbaum Daniel contributionsBy.; Andris Deborah A. contributionsBy.; Ayers Phil contributionsBy.; Baroccas Albert contributionsBy.; Compher Charlene contributionsBy.; Ireton‐Jones Carol contributionsBy.; Jaksic Tom contributionsBy.; Robinson Lawrence A. contributionsBy.; Van Way Charles W. contributionsBy.; Compher Charlene contributionsBy.; Allen Nancy contributionsBy.; Boullata Joseph I. contributionsBy.; Braunschweig Carol L. contributionsBy.; George Donald E. contributionsBy.; Simpser Edwin contributionsBy.; Worthington Patricia A. contributionsBy.
• Is Part Of: JPEN, Journal of parenteral and enteral nutrition. Volume 38:Number 3(2014)
• Page Start: 334
• Page End: 377
• Publication Date: 2014-02-14
• Subjects: parenteral formulas/compounding -- nutrition -- parenteral nutrition -- nutrition -- clinical guidelines -- GRADE; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; 615.85484
• DOI: 10.1177/0148607114521833
• Languages: English
• ISSNs: 0148-6071

Abstract

Abstract : 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 calcium‐phosphate 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?