PURPOSE: In patients where enteral feeding is not possible, the parenteral route is widely accepted as an effective way of delivering nutrition. Creating the perfect mix of macronutrients and micronutrients can be surprisingly tedious and require a nutrition specialist. On the other hand, premixed TPN formulations are available in various different combinations of macro and micronutrients and can be chosen based on the same calculations utilized by experts.They are more uniform in their charateristics. We compared the feasibility of administering premixed TPN as an alternative to customized formulations and its cost implications.
METHODS: A review of forty-seven patients receiving customized TPN at a tertiary care hospital (hospital pharmacy and admixture pharmacy service) was performed and compared with premixed formulation. The amounts of macro and micronutrients formulated in each bag (on day 1,3,5,7) were recorded and averaged to 1000ml. The combination of nutrients in the customized group was carefully monitored, adjusted and administered on a daily basis by a trained clinician. The tabulated data was then compared with the available Clinimix formulations (Baxter International, Inc Deerfield, IL) and percent differences were calculated. The costs and manpower for parenteral nutrition formulations were obtained from the central pharmacy at our institution.
RESULTS: The percentage difference between both formulations for all patient days was 9% for carbohydrates and 15% for proteins on an average. Since premixed micronutrients were only available in one formula they were not easily comparable. The total cost comparison and manpower utilized showed that premixed TPN was 30% cheaper on average. Hospital pharmacy man/hours per day for TPN were 3 man/hours. Pharmacy man/hours for this time study were 987.
CONCLUSIONS: While macronutrients are quite comparable between formulations, any required micronutrients should be managed individually. Premixed TPN without micronutrients appears to be an acceptable alternative to the current standard of customized formulations.
CLINICAL IMPLICATIONS: Premixed TPN has potential savings on resources and ease of use, considering the savings on TPN prescribing personnel and pharmacy costs.
DISCLOSURE: The following authors have nothing to disclose: Sandeep Anantha Sathyanarayana, Gary Deutsch, Narendra Singh, Garry Ritter, Rafael Barrera
No Product/Research Disclosure Information