Newsletter

[ Vol. 13 No. 1 ] (January - April 2012 )
Safety of parenteral nutrition

Jay M. Mirtallo
Clinical Pharmacy, The Ohio State University, College of Pharmacy (United States)

Parenteral nutrition (PN) is a complex therapy that requires a robust system to assure its safety and efficacy. Since its inception, serious adverse effects have been reported for PN ranging from catheter complications such as thrombosis and infection to metabolic complications such as thrombosis and infection to metabolic complications including hyperglycemia, refeeding syndrome and fluid/electrolyte disorders.

Although adverse events for PN are rarely reported, events related to parenteral nutrition are likely to be associated with harm. PN mortality has occurred as the result to contaminated PN admixtures, precipitates of calcium and phosphorus in PN, omission of vitamins from PN (as during the multivitamin shortage in the United States), poorly controlled glucose and electrolyte or dextrose admixture errors. Errors reported to a Medication Error Reporting System (MedMarx and MERP) specific to PN have been the result of performance deficits, communication issues, procedure not followed and knowledge deficits. Errors occurred at every level of the PN process including: prescribing, preparation, distribution, monitoring and evaluation.

PN is a system that requires constant diligence to avoid adverse patient outcomes. The recent drug shortage crisis in the United States provides an example of how fragile the integrity of the PN system could be when a component of the system struggles to fulfill its responsibility. During this shortage, every component pf PN except dextrose has been affected. PN product shortages result in frequent modification to processes in the PN system dependent on whether a PN product is available to the institution. Safety, in this circumstance, is a significant concern to professionals managing PN as well as their patients.

Early PN adverse events led to the recommendation that teams manage intravenous catheters as well as PN. Interdisciplinary care may be an approach to improve the safety of PN. This and other issues will be addressed in this presentation.

From  
The 14^th Congress of Parenteral and Enteral Nutrition Society of Asia
“From Nutrition Support to Nutrition Therapy”
October 14-16, 2011, Taipei, Taiwan 
Page: 6