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Objective:To establish a design of a clinical decision support (CDS) system ithin the computerized physician order entry (CPOE) system to ensure the correct prescribing of total nutrient admixture (TNA) orders.Methods:An improved new workflow was designed in consideration of both the TNA and doctor's prescription work flow. An exclusive CPOE interface for TNA physician order was established, within which a CDS mode was also created. When individual components of the TNA physician order are inputted, automatic calculation is performed through CDS to determine whether patient's clinical nutritional needs and pharmaceutical process requirements are both met. The generated feedback is presented directly to the prescribing clinician in the interface. Through rationality assessment of physician orders and real-time alarm feedback for inappropriate orders, the system can achieve pre-review of TNA orders as well as the education for clinicians on parenteral nutrition order prescription.Results:The usable drug catalog is created at the back end of CDS, thus precluding unreasonable medical orders of therapeutic drugs in TNA regimens. The background CPOE auxiliary support system for parenteral nutrition can correctly evaluate the reasonability of the carrier solution and provide real-time feedback in the CPOE interface.Conclusion:The establishment of the CPOE auxiliary support system eliminates the possibility of unreasonable component proportions and admixture with other therapeutic drugs in TNA orders to ensure TNA orders with rationale component proportion and good compatibility and stability, ultimately satisfying patient's daily calory need and guaranteeing medication safety of parenteral nutrition.
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OBJECTIVE: To investigate the adsorption of insulin in total nutrient admixture solutions(TNA) in three different material disposable parenteral nutrition infusion bags and provide the reference for compounding of parenteral nutrition and clinical nutrition support. METHODS: TNA were compounded according to consensus for parenteral nutrition solutions compounding containing same prescriptions and same dose of insulin in different materialsinfusion bags including polyvinyl chloride(PVC) and ethylene-vinyl acetate copolymer(EVA) and triple chambered bag(TCB). Determination of concentrations of insulin by HPLC for 0, 2, 4, 6, 8, 10, 12, 14, 15 h with infusion speed 40 drops•min-1(2 mL•min-1). RESULTS: The RESULTS of determination in 7 groups of TNA samples at different time points were between 69.5% to 102.8% of the oretical value. The insulin concentrations was low at the initial stage (0 and 2 h, mean difference: 2.4-8.0 IU•L-1). The concentrations of insulin in 4-15 h was no significant difference. There was a significant difference in different material bags:TCBvs EVA (mean difference:2.4 IU•L-1, P=0.012). PVC vs EVA(mean difference:1.6 IU•L-1, P=0.020).CONCLUSION: The adsorption of insulin in EVA material bags is significantly different from that in TCB and PVC, the concentrations of insulin in TNA of different material bags was low in the initial stage (0 and 2 h). There is no significant difference in the concentrations of insulin at 4-15 h. When TNA is compounding in EVA, PVC and KABI nutritional bags, insulin can be used as a way to supplement for patients daily needs.
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Components and compounding of parenteral nutrition solutions were different in different hospitals and different parts of China.In order to raise awareness,reduce improper compounding and improve patient safety,Pharmacy Cooperative Group of Chinese Society for Parenteral and Enteral Nutrition composed the Consensus for Parenteral Nutrition Solutions Compounding,providing evidence for standardization in this field.
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Total parenteral nutrition (TPN) therapy has advanced significantly during the recent half a century, from single bottle therapy to the combined therapy including macronutrients and micronutrients. The purposes of 3-chamber bag development are to reduce the restriction of total nutrient admixture, and increase the accessibility of therapy. This is also based on trial and errors during R&D activities, and the clinical experiences at the hospital compounding centers. The 3-chamber bag started with concerns regarding the mixture of fat and glucose and amino acids, but up to the present, it is used widely with clinical experience of more than 15 years. Therefore, it might be reasonable to ensure that its efficacy and safety is confirmed. The physicians have reported that it contributes to the convenient and efficient nutrition therapy, allowing enhanced patient compliance and convenience at hospital. In addition, depending on the further R&D works, 3-chamber bags are expected to advance further, opening a new landscape for advanced nutrition therapy.
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Amino Acids , Glucose , Micronutrients , Nutrition Therapy , Parenteral Nutrition, Total , Patient ComplianceABSTRACT
Objective To evaluate the effects of iron dextran or iron sucrose on the stability of fat emulsion in total nutrient admixture (TNA) in pediatric settings.Methods TNA with different intravenous doses of iron sucrose or iron dextran (0.25,0.5,0.75,or 1.00 mg) were prepared,and each dose was prepared 10 bags.The TNAs were stored at 25 ℃ for 3 days,and the stability of fat emulsion was observed by electron scanning microscopy.Meanwhile,the pH and osmolality were also measured.Results The particle sizes of fat emulsions in TNA with different concentrations of iron sucrose or iron dextran at different time points were not significantly different (F =0.32,P =0.7836 ; F =1.73,P =0.1321,respectively).The mean particle size of the fat emulsion in each group was ＜ 0.5 μm within 72 hours.For TNA containing different concentrations of iron,the percentage of particles ＞ 0.5 μm,pH,and osmotic pressure showed no significant difference at different time points (percentage:F =1.47,P =0.3467 ; F =1.04,P =0.4758.pH:F =0.63,P =0.5942 ; F =0.46,P =0.6825.osmotic pressure:F =1.37,P =0.3648 ; F =0.65,P =0.6023).Conclusion The TNA addeded with iron sucrose or iron dextran with an concentrations of ＜ 1％ is stable.
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Objective To evaluate the effect of iron on the stability of fat emulsion in total nutrient admixture (TNA) in pediatrics. Methods Based on intravenous nutrition preparation and handling protocols, 0,0.25, 0.50, 0.75, and 1.00 mg iron sucrose was added in each 100 ml TNA, respectively, and each dose was prepared for 10 bags. The stability of fat emulsion was observed by electron scanning microscopy. The pH and osmolality were determined at different time points (0, 24, 48, and 72 h). Results The fat particle size, percentages of particles ＞ 0.5 μm, pH value, and osmolality were not significantly different among all the groups at different time points (all P ＞ 0.05). The mean particle sizes of the fat emulsion were ＜ 0.5 μm in all groups within 72 h.No fat particle with diameter ＞ 5 μm was seen in each group. Conclusion TNA containing iron sucrose with concentrations range 0.25-1.00 mg per 100 ml is stable.
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Objective To study the effect of total nutrient admixture (TNA) on lipid metabolism in rats with acute hepatic failure (AHF). Methods Fifty-six male Wistar rats were randomly divided into four groups: normal diet group, nitrogen-free diet group, fat-free nutrient admixture group, and TNA group. All rats were injected with D-galac- tosamine to induce AHF model Meanwhile, 6 healthy Wistar rats were used as control group. TNA provided energy 221.75 kJ (1 kcal=4.184 kJ), nitrogen 0.365 g, nitrogen to energy ratio 1:145, amino acids 2.28 g (including branched-chain amino acid 0.70 g), glucose 7.85 g, and fat 1.25 g on a daily basis. After 10 days of the operation of Jugular vein puncture tube, blood glucose, blood lipid, liver and renal function were determined. Results The blood glucose level was significantly higher in TNA group than that in fat-free nutrient admixture group (P < 0.05). The levels of serum triglyceride and cholesterol were highest in fat-free nutrition admixture group, and triglyceride level was signif- icantly higher than that in normal diet group and nitrogen-free diet group (P <0.05). The levels of serum triglyceride and cholesterol were significantly higher in TNA group than those in normal diet group (P <0.05). The levels of ala- nine aminotransferase, alkaline phosphatase, total bilirubin and blood urea nitrogen were lower in TNA group than those in fat-free nutrient admixture group (P < 0.05). Conclusion The nutritional proportion of TNA is suitable for the metabolism disorder of hepatic failure, and therefore TNA can reasonably promote the anabolism and reverse the deteri- oration of hepatic failure in rats.
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n admixtures are summarized.
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OBJECTIVE:To provide reference for the establishment of more rational preparation model of total nutrient admixture(TNA).METHODS:The problems existing in the preparation of TNA were discussed and the reasons were ana?lyzed.RESULTS&CONCLUSION:Improvement in TNA formulation,personalized medication;Proper selection of form of medication,dosage and preparation method;The quality control and consultation by the nutritional support group members;Monitoring of the patients,and appropriate adjustment of TNA prescription ratios all can help to improve the quality of TNA and promote its wide use in clinic.
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Objective: To study review the experience of the preparation method of total nutrient admixture(TNA).Methods: 273 patients receive TNA in 2005.More than 4 200 bags of TNA were prepared.Results: There were no infusion reaction and complication in clinical application because of unsuitable preparation.100 bags of TNA were detected for bacteris and all were negative.Conclusion: The ingredients of parenteral nutrition are various and the preparation is important.Strict aseptic technique and preparation procession are wanted.
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OBJECTIVE:To discuss the way to establish a scientific and rational quality guarantee system for total nutrient admixture(TNA).METHODS:The regulations and measures adopted to guarantee TNA quality were analyzed on the basis of TNA preparation practice in the hospital.RESULTS&CONCLUSION:TNA quality can be guaranteed to be secure and stable in quality by establishing an efficient quality guarantee system for TNA.
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0.05).Conclusion:The method of insulin directly added into TNA can efficiently manage the blood glucose level during parenteral nutrition support.
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Objective:To evaluate the stability of fat emulsion in TNA prepared by automated compounding device and compare it with the manual method.Methods:A total of 20 TNA were prepared by the automated compounding device and the conventional manual method.The TNA were stored at 25℃ for 1 day,4℃ for 7days and again 25℃ for 1 day to observe the stability of fat emulsion by electron scanning microscopy measurement and to measure the pH,osmolality.Results:Time required for TNA prepared by automated compounding device was less than the manual method.At the 1st day,the particle size of fat emulsion in TNA prepared by the automated compounding device was smaller than the manual method;After 7 days storing at 4℃ and 1 day at 25℃,the particle size,pH and osmolality were also stable in automated compounding device group.Conclusion:Automated compounding device reduced time requirements for TNA preparation.The stability and compatibility of TNA prepared by automated compounding device is better than the manual method.
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Lipid emulsion, glucose, amino acids, electrolytes, vitamins and trace ele- ments were mixed in a definite order to prepare 10 different total nutrient admixture solutions. The pH and osmolality of these solutions did not change significantly during 14 days of storage at 4℃.Mean diameters of the lipid particles on different occasions for the different solutions varied from 0.3135?0.1012?m to 0.4813?0.1893 ?m. 94.93% of particles were less than 0.6 ?m, and none greater than 6?m. Cultures were all negative.74 patients received 1,796 such infusions. No adverse clinical reactions or abnormal laboratory parameters were observed. Patients on treatment for more than one week showed improved nitrogen balances. Serum transferrin and albumin were increased to varying levels when treatment was for more than two weeks.