Wischmeyer Paul E, Klek Stanislaw, Berger Mette M, Berlana David, Gray Brenda, Ybarra Joe, Ayers Phil
Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, NC, USA.
Surgical Oncology Clinic, The Maria Sklodowska-Curie National Cancer Institute, Krakow, Poland.
Am J Health Syst Pharm. 2024 Jun 13;81(Supplement_3):S89-S101. doi: 10.1093/ajhp/zxae079.
Parenteral nutrition (PN) is an established therapy when oral/enteral feeding is not sufficient or is contraindicated, but nevertheless PN remains a complex, high-alert medication that is susceptible to errors that may affect patient safety. Over time, considerable progress has been made to make PN practices safer. The purpose of this article is to address ongoing challenges to improve the PN use process from prescription to administration and monitoring, and to outline practical aspects fostering the safety, quality, and cost-effectiveness of PN, as discussed at the International Safety and Quality of PN Summit.
Opportunities to improve the PN use process in clinical practice include the promotion of inter-disciplinary communication, vigilant surveillance for complications, staff education to increase competency, and more consistent use of advanced technologies that allow automated safety checks throughout the PN process. Topics covered include considerations on PN formulations, including the value of intravenous lipid emulsions (ILEs), trends in compounding PN, the current and future role of market-authorized multi-chamber PN bags containing all 3 macronutrients (amino acids, glucose/dextrose, and ILE) in the United States and in Europe, and strategies to cope with the increasing global problem of PN product shortages.
This review outlines potential strategies to use in clinical practice to overcome ongoing challenges throughout the PN use process, and ultimately promote PN patient safety.
当口服/肠内喂养不足或禁忌时，肠外营养（PN）是一种既定的治疗方法，但PN仍然是一种复杂的高警示药物，容易出现可能影响患者安全的错误。随着时间的推移，在使PN操作更安全方面已经取得了相当大的进展。本文的目的是应对从处方到给药及监测整个PN使用过程中持续存在的挑战，并概述促进PN安全性、质量和成本效益的实际方面，这是在国际PN安全与质量峰会上讨论的内容。
在临床实践中改善PN使用过程的机会包括促进跨学科沟通、对并发症进行警惕监测、开展员工教育以提高能力，以及更一致地使用先进技术，这些技术可在整个PN过程中进行自动安全检查。涵盖的主题包括对PN配方的考虑，包括静脉脂肪乳剂（ILEs）的价值、PN配制的趋势、在美国和欧洲含有所有三种宏量营养素（氨基酸、葡萄糖/右旋糖和ILE）的市场授权多腔PN袋的当前及未来作用，以及应对全球范围内PN产品短缺这一日益严重问题的策略。
本综述概述了在临床实践中可采用的潜在策略，以克服整个PN使用过程中持续存在的挑战，并最终促进PN患者的安全。
