Total Parenteral Nutrition Solutions

 

• Total parenteral nutrition (TPN) – IV solutions that provide long-term nutritional support for a specific patient population.

  
  

  TPN Components: approximately 15 components including:
• • Sterile water for hydration
  • Dextrose for calories and energy
  • Amino acids for protein synthesis
  • Fatty acids for chemical processes and energy
  • Additives: electrolytes, vitamins, and minerals
  • Medication for treatment of a disease or disorder
• Preparing a TPN: 1,000 to 2,000 mL to provide nutritional support for 12 – 24 hours.

  Automated compounding device (ACD) – for the preparation of large volumes of TPN solutions.

  IV fat emulsion is known as a 3-in-1 TPN solution.

  
  

  Administering TPN: central venous catheter (CVC) – central line, into the subclavian vein – is required form the administration of a TPN.

• • Premade Parenteral Products

  • Premade parenteral products benefits the hospital pharmacy, the nursing staff and the patients.

    These commercially available products come as:
  • • Vial-and-bag systems
    • Frozen sterile IV solutions
  • The expiration date varies compared with standard beyond-use dating. The expiration date is based on scientific studies and can be found on the product, and can be found on the vial or in the product package insert.
  • Vial-and-bag system – provides both a single vial of powdered medication with an adaptor and a specified IV solution that acts as the diluent.

    Types of Vial-and-Bag Systems: ADD-Vantage (Hospira), MINI-BAG Plus (Baxter Healthcare); not considered CSPs.

    Stability and expiration date varies with the type and concentration of the drug, diluent, storage conditions, and activation.
  • Some of the benefits of vial-and-bag systems include less wastage, improved safety, efficiency, and cost-effectiveness.

    Safety: admixing errors are minimized; risk of contamination is also minimized.

    Efficiency: doses are premeasured for rapid reconstitution and easy assembly.

    Cost-effectiveness: no admixing is necessary and no additional supply costs.Each vial-and-bag system differs somewhat, but the concept is similar.

    The vial of drug – that is not reconstituted – is coupled (with or without an adaptor) with an appropriate volume of IV solution.

    Assembly: the technician is responsible for assembly; performed in the hood to maintain sterility.

    Activation: nursing staff is responsible for activation.
  • Commercially available products and are not considered CSPs.

    Most are antibiotics and are manufactured as SVPs in a premixed frozen state.

    Handling of Frozen IV Solutions: kept in the freezer until an order is received; the product is then thawed at room temp. or in the refrigerator.

    Expiration date varies with the drug and storage conditions.

      • Ancef – expiration date of 48 hours at room temp., 30 days in the refrigerator

      • Zosyn – expiration date of 24 hours at room temp., 14 days in the refrigerator
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