Home parenteral nutrition (HPN) is increasingly prescribed for patients with advanced cancer. This therapy improves free-fat mass, quality of life and survival, but it is not free from complications, especially catheter-related bloodstream infections (CRBSIs). The use of commercial multichamber bags in HPN has not been extensively explored in oncologic patients and their association with complications is not well known. In this prospective cohort study, we included 130 patients with advanced cancer and HPN. We compared the effects of individual compounded bags (n = 87) vs. commercial multichamber bags (n = 43) on complications. There were no differences in any complication, including thrombosis ( > 0.05). There were 0.28 episodes of CRBSI per 1000 catheter days in the individual compounded bag group and 0.21 in the multichamber bag group ( > 0.05). A total of 34 patients were weaned off HPN, 22 with individual bags and 12 with multichamber bags ( = 0.749). Regarding survival when on HPN, the group with individual bags showed a median of 98 days (95% CI of 49-147), whereas those with multichamber bags showed a median of 88 days (95% CI of 43-133 ( = 0.913)). In conclusion, commercial multichamber bags for HPN in patients with advanced cancer are non-inferior when compared to individual compounded bags in terms of complications.
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http://dx.doi.org/10.3390/nu16030457 | DOI Listing |
JPEN J Parenter Enteral Nutr
January 2025
Department of Pharmacy, Mississippi Baptist Medical Center, Jackson, Mississippi, USA.
Parenteral nutrition (PN), a high-alert medication, is an important lifesaving modality. The American Society for Parenteral and Enteral Nutrition (ASPEN) has historically provided guidelines and recommendations for the safe and efficacious use of PN. These recommendations have included detailed guidance regarding the compounding of this highly complex medication.
View Article and Find Full Text PDFNutr Clin Pract
December 2024
Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Background: In light of the complex and high-risk nature of parenteral nutrition (PN), reviewing PN processing steps is essential to minimize patient harm. The main steps include ordering, verification, compounding, and administration. Electronic health records (EHRs) have become increasingly utilized and can play a critical role in enhancing the safety of PN processin.
View Article and Find Full Text PDFNutrients
November 2024
School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
Background: Parenteral nutrition (PN) is required by people with intestinal failure and can be delivered as multi-chambered bags (MCBs) or individually compounded (COM) bags. This systematic review aimed to examine the evidence base for clinical outcomes and/or quality of life (QoL) in adults receiving PN as MCBs compared to COMs in hospital and community settings.
Methods: A systematic database search was conducted between January 2015 and May 2024.
Clin Nutr ESPEN
December 2024
The University of Manchester, United Kingdom; National Intestinal Failure Reference Centre, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom.
Background & Aims: Home Parenteral Nutrition (HPN) prescriptions should be tailored to a patient's nutritional requirements and comprise of individually compounded regimens (IC-HPN) or standard licensed multi-chamber bags (MCB). There is a paucity of research exploring factors associated with admixture type. This study aimed to evaluate the nutrient composition of adult IC-HPN prescriptions and variance in nutrient dosing, make comparisons with the range of MCB available and dosing recommendations stated in international guidelines.
View Article and Find Full Text PDFClin Nutr ESPEN
December 2024
Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK; School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
Background & Aims: There is varied international practice in the use of ready-made multi-chamber bags (MCBs) and compounded parenteral nutrition (PN). Recent national aseptic pharmacy capacity limitations have restricted compounded PN production so we aimed to explore outcomes associated with the increased use of MCB vs compounded regimens during a period of change in PN supplies.
Methods: This was a point prevalence study conducted over two time periods, Period 1: 01.
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