Regardless of whether the PN admixture is compounded or commercially available (ie, MCB), when the ILE is included as part of the PN admixture its thermodynamic stability is further reduced. The choices of delivery system and type of preparation will vary by the institution, region, or country.įat droplets tend to join together over time, making ILE products thermodynamically unstable.
Alternatively, the PN admixture can be prepared from commercially available multi-chamber bags (MCBs 2-chamber or 3-chamber), with the latter containing ILE with the other 2 macronutrients. The PN admixture may be compounded by a pharmacy-either customized to individual patients or standardized for patient subsets. There are also different types of PN preparations depending on how they are made and whether the proportions of macronutrients are standardized or customized to a patient's needs.
These are the types of PN formulation delivery systems. The 3-in-1 system (ie, all-in-1 or total nutrient admixture ) has all 3 macronutrients and the micronutrients in a single bag. Separate ILE administration may occur using the multi-bottle system, or more commonly in the 2-in-1 system (2 macronutrients and all micronutrients in a single bag ILE separate). The ILE product may or may not be administered separately from all the other intravenous nutrients. 2, 3 Despite sharing these general characteristics, ILE products differ from each other in terms of the oil source(s), lipid concentration, fatty-acid composition, and other ingredients such as vitamin E and phytosterols.
The ILE products therefore contain thousands of fat droplets per mL, with a mean diameter of ≈0.25–0.5 µm that are each kept separate from one another, providing a stable shelf life of 18–24 months. Emulsification allows the oil and water phases to exist together at a lower surface tension, to create commercial products with a homogeneous dispersion of sub-micron fat droplets in water. This combination is acceptable thanks to the use of an appropriate emulsifier. All commercially available ILEs are thermodynamically complex oil-in-water mixtures. As with all therapeutic interventions, the benefits of ILE outweigh the potential risks, as long as these risks are taken into account. Of the many vital components of a PN regimen, the intravenous lipid emulsion (ILE) with its various ingredients, is available for providing a dense source of energy as well as essential and conditionally essential fatty acids. PN remains a valuable therapeutic intervention in adults and children across care settings, whether used for the short-term or long-term. If using repackaged ILEs, e.g., transferred into syringes or other bags, the infusion duration should not exceed 12 hours to minimize the risk of contaminationĥ7% agreement (8 agree, 2 do not agree, 4 do not wish to answer) If using all-in-one admixtures, the preferable maximum infusion duration is 24 hours However, if this is necessary it should be under aseptic conditions To reduce the risk of contamination, we recommend avoiding repackaging of ILEs into other bags or syringes. When compounding is necessary, ensure that the prescribed formulation is reviewed and prepared under the supervision of an expert pharmacistġ00% agreement (14 agree, 0 do not agree, 0 do not wish to answer) The group recommends considering the use of commercially available multi-chamber bags or compounded bags, depending on local expertise and economic considerationsĨ6% agreement (12 agree, 1 does not agree, 1 does not wish to answer)
In accordance with major guidelines, a higher rate of standardization of the PN process to minimize potential risks associated with PN (from prescription to administration) is advocatedġ00% agreement (15 agree, 0 do not agree, 0 do not wish to answer)