ABSTRACT
Objective@#To establish a quality control model ensuring good stability and compatibility of manually compounded total nutrient admixtures (TNA).@*Methods@#A parenteral nutrition medication order entry system was establish for standardizing nutritional medication usage and supporting physician's TNA prescribing. TNA medication orders were reviewed by pharmacists for validating the stability and compatibility. TNAs were compounded by pharmacists in a standard way following "four factors of sterile compounding" . The goal of quality control was achieved by establishment of the preliminary standard.@*Results@#The quality of manually compounded total nutrient admixtures achieved the goal since pharmacy intravenous admixture service (PIVAS) started on 2003.@*Conclusions@#The quality of TNA is well assured while manually compounded by pharmacists in PIVAS.
ABSTRACT
Objective To establish a quality control model ensuring good stability and compatibility of manually compounded total nutrient admixtures (TNA). Methods A parenteral nutrition medication order entry system was establish for standardizing nutritional medication usage and supporting physician's TNA prescribing. TNA medication orders were reviewed by pharmacists for validating the stability and compatibility. TNAs were compounded by pharmacists in a standard way following "four factors of sterile compounding". The goal of quality control was achieved by establishment of the preliminary standard. Results The quality of manually compounded total nutrient admixtures achieved the goal since pharmacy intravenous admixture service (PIVAS) started on 2003. Conclusions The quality of TNA is well assured while manually compounded by pharmacists in PIVAS.
ABSTRACT
PURPOSE: Conventional intravenous nutrition has been given as a solution of amino acids combined with dextrose and a separate line delivering a lipid emulsion. This technique was unsatisfactory, however, because of difficulties in managing technical and metabolic complications. Since the first clinical use of a single solution containing all the necessary nutrients was introduced in 1976, the total nutrient admixture (TNA) system has been used. However, despite the numerous advantages of this TNA system, it has not been used worldwide because of an assumption about unstability of this admixture. This study was conducted to compare the physical stability of TNA systems using two different 2 commercially available amino acid solutions and fat emulsions. METHODS: Each group contained 600 ml of 20% dextrose, 250 ml of 10% amino acid solution, 250 ml of 10% fat emulsion, 0.2 ml of heparin, and 20 ml of electrolyte solution was investigated for 7 days while being stored 4oC and at ambient temperature. The stabilities of these admixtures were compared by noting changes in macroscopic appearance, pH, osmolarity, Zeta-potential, peroxide value, particle size and distribution, and fat composition. RESULTS: When an amino acid solution containing P 2 was used, a supernatant yellow band was observed from the 3rd day at ambient temperature. The pH and peroxide value also showed significant changes, but these changes did not exceed the product-specifications. When an amino acid solution without P 2 was used, no significant change was observed. CONCLUSION: TNA systems are physically stable at 4oC temperature for at least 7 days, but TNA systems prepared with amino acid solution containing P 2 are not stable at ambient temperature from the 3rd day. On the other hand, TNA systems prepared with an amino acid solution without P 2 are stable at ambient temperature for 7 days. Various commercially available fat emulsions containing 10% soybean oil did not affect the stability of TNA systems.