Parenteral nutrition in clinical practice: International challenges and strategies

Abstract

Purpose: Parenteral nutrition (PN) is an established therapy when oral/enteral feeding is not sufficient or is contraindicated, but nevertheless PN remains a complex, high-alert medication that is susceptible to errors that may affect patient safety. Over time, considerable progress has been made to make PN practices safer. The purpose of this article is to address ongoing challenges to improve the PN use process from prescription to administration and monitoring, and to outline practical aspects fostering the safety, quality, and cost-effectiveness of PN, as discussed at the International Safety and Quality of PN Summit.

Summary: Opportunities to improve the PN use process in clinical practice include the promotion of inter-disciplinary communication, vigilant surveillance for complications, staff education to increase competency, and more consistent use of advanced technologies that allow automated safety checks throughout the PN process. Topics covered include considerations on PN formulations, including the value of intravenous lipid emulsions (ILEs), trends in compounding PN, the current and future role of market-authorized multi-chamber PN bags containing all 3 macronutrients (amino acids, glucose/dextrose, and ILE) in the United States and in Europe, and strategies to cope with the increasing global problem of PN product shortages.

Conclusion: This review outlines potential strategies to use in clinical practice to overcome ongoing challenges throughout the PN use process, and ultimately promote PN patient safety.

Keywords: Parenteral nutrition; compounding; lipids; multi-chamber bags; preparation; product shortages; safety.

Figure 1.

The parenteral nutrition (PN) use process: potential sources and reported incidence of errors. Compiled using data from references 2 through 7.

Figure 2.

Major aspects of the improvement of parenteral nutrition (PN) formulations and the PN process in clinical practice. MCB indicates multichamber bag; TE, trace element; US, United States.