Sugrue David, Jarrell Andrew S, Kruer Rachel, Davis Stephanie, Johnson Dachelle, Tsui Evelyn, Snyder Sukyee, Crow Jessica
Department of Pharmacy, The Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie Bldg Room 180, Baltimore, MD 21287, USA.
Clinical Center Pharmacy Department, National Institutes of Health, 10 Center Drive, Room 1C240, Bethesda, MD 20892, USA.
Clin Nutr ESPEN. 2018 Feb;23:117-121. doi: 10.1016/j.clnesp.2017.11.004. Epub 2017 Dec 2.
BACKGROUND & AIMS: Current evidence and guidelines identify patient populations who may benefit from parenteral nutrition. Peripheral parenteral nutrition (PPN) may be indicated for a subset of patients; however, PPN therapy carries a risk of associated adverse effects. The purpose of this project was to assess appropriateness of current PPN prescribing practices at an academic medical center to determine whether additional guidance and oversight may be beneficial.
Adult patients admitted from August 1, 2015 to November 30, 2015 with at least one order of PPN administered were included. PPN use was evaluated for appropriateness using definitions derived from clinical practice guidelines and standard of practice. Adverse events, including phlebitis and bacteremia, were also examined.
Of the 159 patients included, 51 (32.1%) received appropriate PPN therapy, in which all four criteria for appropriateness were met. In regards to the criteria for appropriateness, 128 (80.5%) had an appropriate indication, 85 (53.5%) had appropriate time to PPN initiation, 157 (98.7%) had an appropriate duration of therapy, and 112 (70.4%) achieved an appropriate percentage of goal daily calories. In terms of complications associated with PPN therapy, 69 (43.4%) patients had documented phlebitis and bacteremia occurred in 5 (3.1%) of the patients.
During the study period, PPN was appropriately utilized in only one-third of patients and phlebitis occurred in almost half of all patients. Restrictions on PPN prescribing may allow nutrition support clinicians to prospectively evaluate patients to optimize nutrition therapy and minimize the incidence of inappropriate PPN use.
当前的证据和指南确定了可能从肠外营养中获益的患者群体。外周肠外营养（PPN）可能适用于一部分患者；然而，PPN治疗存在相关不良反应的风险。本项目的目的是评估某学术医疗中心当前PPN处方实践的合理性，以确定额外的指导和监督是否有益。
纳入2015年8月1日至2015年11月30日期间入院且至少接受过一次PPN治疗的成年患者。使用从临床实践指南和实践标准中得出的定义评估PPN的使用合理性。还检查了包括静脉炎和菌血症在内的不良事件。
在纳入的159例患者中，51例（32.1%）接受了适当的PPN治疗，满足所有四项合理性标准。关于合理性标准，128例（80.5%）有适当的适应证，85例（53.5%）有开始PPN的适当时间，157例（98.7%）有适当的治疗持续时间，112例（70.4%）达到了目标每日热量的适当百分比。在与PPN治疗相关的并发症方面，69例（43.4%）患者记录有静脉炎，5例（3.1%）患者发生菌血症。
在研究期间，只有三分之一的患者适当使用了PPN，几乎一半的患者发生了静脉炎。对PPN处方的限制可能使营养支持临床医生能够前瞻性地评估患者，以优化营养治疗并尽量减少不适当使用PPN的发生率。
