Fewer hospitals are now preparing TPN solutions from scratch. Standard-isation of regimens for adults, paediatrics and neonates has enabled com-mercial manufacturers with specials licences to take a significant part of the TPN market.
Total parenteral nutrition
Fewer hospitals are
now preparing TPN solutions from scratch. Standard-isation of regimens for
adults, paediatrics and neonates has enabled com-mercial manufacturers with specials
licences to take a significant part of the TPN market. However, the greatest
impact has been the introduction of technologies such as multicompartmental TPN
bags, which enable manu-facturers to provide macronutrients in standard
quantities as terminally ster-ilised solutions in individual compartments of
the bag. These presentations have long shelf-lives, often at room temperature,
and are activated to permit mixing of components immediately before use. Many
of the hospitals where TPN is still compounded prepare or purchase batches of
‘base TPN’ bags in which macronutrients (glucose, amino acids, lipid and water)
are present in standard amounts. Standard TPN formulations are available with
standard electrolyte concentrations or as electrolyte-free solutions to which
patient-specific electrolytes can be added before administration. In all cases,
it is necessary to add unstable components such as vitamins and trace elements
prior to use.
Standard formulae
are satisfactory for the majority of patients requiring TPN and there is no
scientific or clinical evidence to support some of the very complex
individualised preparations that have been used in the past. It must be
recognised, however, that some patients (for example, renal patients) have
specific needs and the NHS must retain the expertise and capacity to com-pound
individualised TPN feeds in cases of genuine clinical need. The 2010 National
Confidential Enquiry report A Mixed Bag addresses many of the clinical aspects
of decision-making and use of TPN.
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