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Our smart Admixing Guide aims to support you by providing compatibility and stability information in a concise and user-friendly way.
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Parenteral Nutrition
PN is indicated in a broad range of vulnerable patients across diverse clinical settings – from the intensive care unit (ICU) to patients receiving home PN (HPN)*. It contains essential macronutrients like amino acids, carbohydrates and lipids, as well as micronutrients such as electrolytes, trace elements and vitamins.1
With as many as 50 ingredients and the involvement of multiple disciplines and process steps, the PN use process is susceptible to errors and contaminations as well as needlestick injuries (NSIs).1–4 Proper PN use demands a high level of expertise to ensure patient safety.1–4
To help manage these potential risks, easy-to-use and smart delivery systems are needed to effectively protect both patients and caregivers.4–6
*When oral or enteral nutrition (EN) is not possible, insufficient or contraindicated.
3-16 errors per 1,000 prescriptions in different settings of the PN use process4
With the high complexity of the PN use process, dose appropriateness, compatibility and stability of the PN order are all critical elements of the overall PN use process.4
MCBs can help to reduce potential errors during the PN use process, making them an efficient, cost-effective and time-saving option.7–9
ExploreBy default, PN is considered a high-alert medication with a significant risk of harm if used incorrectly, including severe clinical consequences and increased costs.1–3
Potential errors can occur during all process steps in the PN use process and affect all the disciplines involved, including dietitians, nurses, clinicians, and pharmacists. Preparation, compounding and dispensing are among the leasing sources of errors in the PN use process (24–42%).4
Critical and chronic illness is frequently accompanied by metabolic complications, which can have a detrimental impact on patient outcomes. Parenteral lipid emulsions have evolved and are the most distinguishing factor of PN regarding patient recovery.10
Latest generation lipid emulsions combine different lipid emulsions with the aim of improving patient outcomes. Some mixed lipid emulsions also contain Omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) known for their anti-inflammatory, immunomodulatory, and antioxidative properties.10
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In 2019, the Global Leadership Initiative on Malnutrition (GLIM) stated that malnutrition and inflammation are correlated: malnutrition may also be caused by disease-associated inflammatory or other mechanisms. Therefore, GLIM includes inflammation as an important marker in the diagnosis of disease-related malnutrition.11
ExploreThis consensus on global standards of clinical practice of malnutrition diagnosis came from several clinical nutrition societies (i. e. ESPEN, ASPEN, FELANPE, PENSA) and responded to the needs of the clinical nutrition and medical communities.11
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Vitamins act as catalysts in many metabolic processes and can rapidly be depleted depending on the particular illness and treatments.
IV vitamins are an effective way of filling the gap whenever oral or enteral delivery is impossible, insufficient or contraindicated.12
Read moreMost patients commence PN in a state of vitamin depletion often caused by diseases and treatments that have impaired uptake and increased vitamin losses.12 Serious illness increases metabolic consumption of vitamins, and inadequate vitamin intake directly impairs optimal metabolic function.13
Prescribing, preparing, and administering vitamins is complex due to the combination of 13 individual vitamins all with different chemical properties.
ExploreGet our latest information on PN admixing or read more about home PN.
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Our smart Admixing Guide aims to support you by providing compatibility and stability information in a concise and user-friendly way.
A valuable treatment option for home parenteral nutrition.
1. Berlana D. Parenteral Nutrition Overview. Nutrients. 2022 Oct 25;14(21):4480.
2. Boullata JI. Overview of the parenteral nutrition use process. JPEN J Parenter Enteral Nutr. 2012 Mar;36(2 Suppl):10S–13S.
3. 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. 2017 Sep;41(7):1162–1177.
4. Wischmeyer PE, Klek S, Berger MM, Berlana D, Gray B, Ybarra J, Ayers P. Parenteral nutrition in clinical practice: International challenges and strategies. Am J Health Syst Pharm. 2024 Jun 13;81(Supplement_3):S89–S101.
5. Monczka J, Ayers P, Berger MM, Wischmeyer PE. Safety and quality of parenteral nutrition: Areas for improvement and future perspectives. Am J Health Syst Pharm. 2024 Jun 13;81(Supplement_3):S121–S136.
6. Alfonso JE. Beyond Needlesticks – Multi-Chamber Bags Enhanced with Smart Injection and Infusion Technology [Internet]. Pennsylvania (US): Drug Association Information (DIA);2024 [cited 2024 Nov 24]. Available from: https://globalforum.diaglobal.org/issue/november-2024/#bbraun .
7. 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. 2019 May;43(4):557-565.
8. Berlana D, Sabin P, Gimeno-Ballester V, Romero-Jiménez R, Zapata-Rojas A, Marquez E, Martínez-Cutillas J, Schoenenberger-Arnaiz JA. Cost analysis of adult parenteral nutrition systems: three-compartment bag versus customized. Nutr Hosp. 2013 Nov 1;28(6):2135–41.
9. Berlana D, Barraquer A, Sabin P, Chicharro L, Pérez A, Puiggrós C, Burgos R, Martínez-Cutillas J. Impact of parenteral nutrition standardization on costs and quality in adult patients. Nutr Hosp. 2014 Aug 1;30(2):351-8.
10. Calder PC, Waitzberg DL, Klek S, Martindale RG. Lipids in Parenteral Nutrition: Biological Aspects. JPEN J Parenter Enteral Nutr. 2020 Feb;44 Suppl 1:S21–S27.
11. Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats A, Crivelli A, Evans DC, Gramlich L, Fuchs-Tarlovsky V, Keller H, Llido L, Malone A, Mogensen KM, Morley JE, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren MAE, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J, Van Gossum A, Compher C; GLIM Core Leadership Committee; GLIM Working Group. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr. 2019 Feb;38(1):1–9.
12. Berger MM, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski HK, Bischoff SC, Casaer MP, Gundogan K, Lepp HL, de Man AME, Muscogiuri G, Pietka M, Pironi L, Rezzi S, Cuerda C. ESPEN micronutrient guideline. Clin Nutr. 2022 Jun;41(6):1357–1424.
13. Amrein K, de Man AME, Dizdar OS, Gundogan K, Casaer MP, Lepp HL, Rezzi S, van Zanten AR, Shenkin A, Berger MM; ESPEN Micronutrient Special Interest Group (SIG-MN). LLL 44 - 2 - Micronutrients in clinical nutrition: Vitamins. Clin Nutr ESPEN. 2024 Jun;61:427–436.
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