Objective: To present a guideline-derived mnemonic that provides a systematic monitoring process to increase pharmacists’ confidence in total parenteral nutrition (TPN) monitoring and improve safety and efficacy of TPN use. Data Sources: The American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines were reviewed. Additional resources included a literature search of PubMed (1980 to May 2016) using the search terms: total parenteral nutrition, mnemonic, indications, allergy, macronutrients, micronutrients, fluid, comorbidities, labs, peripheral line, and central line. Articles (English-language only) were evaluated for content, and additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language observational studies, review articles, meta-analyses, guidelines, and randomized trials assessing monitoring parameters of TPN were evaluated. Data Synthesis: The ASPEN guidelines were referenced to develop key components of the mnemonic. Review articles, observational trials, meta-analyses, and randomized trials were reviewed in cases where guidelines did not adequately address these components. Conclusions: A guideline-derived mnemonic was developed to systematically and safely manage TPN therapy. The mnemonic combines 7 essential components of TPN use and monitoring: Indications, Allergies, Macro/Micro nutrients, Fluid, Underlying comorbidities, Labs, and Line type.
JeejeebhoyK.Total parenteral nutrition: potion or poison?Am J Clin Nutr. 2001;74:160-163.
2.
BoullataJ.Overview of the parenteral nutrition use process. JPEN J Parenter Enteral Nutr. 2012;36:10S-13S.
3.
SacksGRoughSKudskK.Frequency and severity of harm of medication errors related to the parenteral nutrition process in a large university teaching hospital. Pharmacotherapy. 2009;29:966-974.
4.
McCleadRECattCDavisJT. An internal quality improvement collaborative significantly reduces hospital-wide medication error related adverse drug events. J Pediatr. 2014;165:1222-1229.
5.
ShulmanRMcKenzieCALandaJ. Pharmacist’s review and outcomes: treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK). J Crit Care. 2015;30:808-813.
6.
TripathiSCrabtreeHFryerK. Impact of clinical pharmacist on the pediatric intensive care practice: an 11-year tertiary center experience. J Pediatr Pharmacol Ther. 2015;20:290-298.
7.
BroylesJEBrownROVeheKL. Pharmacist interventions improve fluid balance in fluid-restricted patients requiring parenteral nutrition. Ann Pharmacother. 1991;25:119-122.
8.
McDermottLAAlbrechtJTGoodDH.Nutritional support: pharmacists’ influence on the prescribing process. Top Hosp Pharm Manage. 1994;14:30-39.
9.
RollinsCDurfeeSMHolcombeBJ. Standards of practice for nutrition support pharmacists. Nutr Clin Pract. 2008;23:189-194.
BoullataJIGuenterPMirtalloJM.A parenteral nutrition use survey with gap analysis. JPEN J Parenter Enteral Nutr. 2013;37:212-222.
12.
BoitanoMBojakSMcCloskeyS. Improving the safety and effectiveness of parenteral nutrition: results of a quality improvement collaboration. Nutr Clin Pract. 2010;25:663-671.
13.
O’NealBCSchneiderPJPedersenCAMirtalloJM.Compliance with safe practices for preparing parenteral nutrition formulations. Am J Health Syst Pharm. 2002;59:264-269.
14.
SeresDSacksGPedersenC. Parenteral nutrition safe practices: results of the 2003 American Society for Parenteral and Enteral Nutrition Survey. JPEN J Parenter Enteral Nutr. 2006;30:259-265.
15.
VincentJL.Give your patient a fast hug (at least) once a day. Crit Care Med. 2005;33:1225-1229.
16.
MassonSCMabasaVHMalyukDLPerrottJL.Validity evidence for FASTHUG-MAIDENS, a mnemonic for identifying drug-related problems in the intensive care unit. Can J Hosp Pharm. 2013;66:157-162.
17.
ASPEN Board of directors. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. (2002). JPEN J Parenter Enteral Nutr. 2002;26:1SA-138SA.
18.
GianottiLMeierRLoboDN. ESPEN guidelines on parenteral nutrition: pancreas. Clin Nutr. 2009;28:428-435.
19.
ParrishCMadsenHFrankelE.The hitchhiker’s guide to parenteral nutrition management for adult patients. Pract Gastroenterol. 2006;30:46-68.
20.
MuellerCBorrielloRPerlov-AntzisL.Parenteral nutrition support of a patient with chronic mesenteric artery occlusive disease. Nutr Clin Pract. 1993;8:73-77.
21.
Al-GhamdiMBediAReddySB. Chylous ascites secondary to pancreatitis: management of an uncommon entity using parenteral nutrition and octreotide. Dig Dis Sci. 2007;52:2261-2264.
22.
NairSKPetkoMHaywardMP.Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg. 2007;32:362-369.
23.
BleierJHedrickT.Metabolic support of the enterocutaneous fistula patient. Clin Colon Rectal Surg. 2010;23:142-148.
24.
SeethramPRodriquesG.Short bowel syndrome: a review of management options. Saudi J Gastroenterol. 2011;17:229-235.
25.
SjogrenRW.Gastrointestinal motility disorders in scleroderma. Arthritis Rheum. 1994;37:1265-1282.
26.
McClaveSAMartindaleRGVanekVW. Guidelines for the provision and assessment of nutrion support therapy in the adult critically ill patient. JPEN J Parenter Enteral Nutr. 2009;33:277-316.
27.
BragaMLjungqvistOSoetersP. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr. 2009;28:378-386.
28.
StaceyRGreenJ.Radiation-induced small bowel disease: latest developments and clinical guidance. Ther Adv Chronic Dis. 2014;5:15-29.
29.
LunnMFausnightT.Hypersensitivity to total parenteral nutrition fat emulsion component in an egg allergic child. Pediatrics. 2011;128:1025-1028.
GuraKMParsonsSKBechardLJ. Use of a fish oil-based lipid emulsion to treat essential fatty acid deficiency in a soy allergic patient receiving parenteral nutrition. Clin Nutr. 2005;24:839-847.
32.
NagataM.Hypersensitivity reactions associated with parenteral nutrition: case report and review of the literature. Ann Pharmacother. 1993;27:174-177.
WorthingtonPGilbertK.Parenteral nutrition: risks, complications, and management. J Infus Nurs. 2012;35:52-64.
35.
GriffithsRD.Too much of a good thing: the curse of overfeeding. Crit Care. 2007;11:176.
36.
SingerPBergerMVan den BergheG. ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr. 2009;28:387-400.
37.
BuchmanALHowardLJGuenterP. Micronutrients in parenteral nutrition: too little or too much? The past, present, and recommendations for the future. Gastroenterology. 2009;137:S1-S6.
ParrishC.Trace element monitoring and therapy for adult patients receiving long term total parenteral nutrition. Pract Gastroenterol. 2005;29:51-65.
40.
YinRPhungO.Effect of chromium supplementation on glycated hemoglobin and fasting plasma glucose in patients with diabetes mellitus. Nutrition Journal. 2015;14:14.
41.
ShikeMRouletMKurianR. Copper metabolism and requirements in total parenteral nutrition. Gastroenterology. 1981;81:290-297.
42.
KafritsaYFellJLongS. Long term outcome of brain manganese deposition in patients on home parenteral nutrition. Arch Dis Child. 1998;79:263-265.
43.
NagatomomSUmeharaFHanadaK. Manganese intoxication during total parenteral nutrition: report of two cases and review of the literature. J Neurol Sci. 1999;162:102-105.
44.
ShenkinA.Selenium in intravenous nutrition. Gastroenterology. 2009;137:S61-S69.
45.
ForbesA.Iron and parenteral nutrition. Gastroenterology. 2009;137:S47-S54.
46.
PembertonLPembertonDCuddyPG. Treatment of Water, Electrolyte, and Acid-Base Disorders in the Surgical Patient. New York, NY: McGraw-Hill; 1994:320-325.
47.
WilliamsFBranskiLJeschkeMHerndonD.What, how, and how much should burn patients be fed. Surg Clin North Am. 2011;91:609-629.
BergerM.Vitamin C requirements in parenteral nutrition. Gastroenerology. 2009;137:S70-S78.
50.
McClaveSTaylorBMartindaleR. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society of Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2016;33:159-211.
51.
MagajiVJohnstonJ.Inpatient management of hyperglycemia and diabetes. Clin Diabetes. 2011;29:3-9.
52.
AgoliniGFumiL.Intravenous nutritional support during pregnancy. JPEN J Parenter Enteral Nutr. 1989;13:441-442.
53.
MooreT. Diabetes in pregnancy. In: CreasyRKResnikR, eds. Maternal-Fetal Medicine. 4th ed.Philadelphia, PA: W B Saunders; 1999:965-970.
54.
WiednerLFishJTalabiskaDGJensenGL.Total parenteral nutrition in pregnant patient with hyperemesis gravidarum. Nutrition. 1993;9:446-450.
55.
PlauthMCabreECampilloB. ESPEN guidelines on parenteral nutrition: hepatology. Clin Nutr. 2009;28:436-444.
56.
HwangTLueMChenL.Early use of cyclic TPN prevents further deterioration of liver functions for the TPN patients with impaired liver function. Hepatogastroenterology. 2000;47:1347-1350.
57.
ChobanPDickersonRMaloneA. ASPEN clinical guidelines nutrition support of hospitalized adult patients with obesity. JPEN J Parenter Enteral Nutr. 2013;37:714-744.
58.
AnkerSDLavianoAFilippatosG. ESPEN guidelines on parenteral nutrition: on cardiology and pneumology. Clin Nutr. 2009;28:455-460.
59.
BrownROCompherC, ASPEN Board of Directors. ASPEN clinical guidelines: nutritional support in adult acute and chronic renal failure. JPEN J Parenter Enteral Nutr. 2010;34:366-377.
LeeV.Liver dysfunction associated with parenteral nutrition: what are the options?Pract Gastroenterol. 2006;45:49-68.
62.
O’GradyNPAlexanderMDellingerEP. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control . 2002;30:476-489.
63.
CooperBPenneEBartlettLPollockC.Protein malnutrition and hypoalbuminemia as predictors of vascular events and mortality in ESRD. Am J Kidney Dis. 2004;43:61-66.
64.
ReynoldsRPadfieldPSeckiJ.Disorders of sodium balance. BMJ. 2006;25:702-705.
65.
MartiGSchwarzCLeichtleAB. Etiology and symptoms of severe hypokalemia in emergency department patients. Eur J Emerg Med. 2014;21:46-51.
66.
MoeSM.Disorders involving calcium, phosphorus, and magnesium. Primary Care. 2008;35:215-237.
67.
FrankelD.Supplementation of trace elements in parenteral nutrition: rationale and recommendations. Nutr Res. 1993;13:583-596.
68.
ItoYAlcockNShilsME.Chromium content of total parenteral nutrition solutions. JPEN J Parenter Enteral Nutr. 1990;14:610-614.
69.
FuhrmanMHermannVMasidonskiPEbyC.Pancytopenia after removal of copper from total parenteral nutrition. JPEN J Parenter Enteral Nutr. 2000;24:361-366.
70.
MasumotoKSuitaSTaquichiT. Manganese intoxication during intermittent parenteral nutrition: report of two cases. JPEN J Parenter Enteral Nutr. 2001;25:95-99.
71.
O’DonnellKRadiganA.Hypermanganesemia in an acute care setting. Nutr Clin Pract. 2003;18:374-376.
72.
AlvesGThiebotJTracquiA. Neurologic disorders due to brain manganese deposition in a jaundiced patient receiving long term parenteral nutrition. JPEN J Parenter Enteral Nutr. 1997;21:41-45.
73.
IshidaTHimenoKTorigoeY. Selenium defiency in a patient with Crohn’s disease receiving long term parenteral nutrition. Intern Med. 2003;42:154-157.
74.
KhaodhiarLKeane-EllisonMTawaNE. Iron deficiency anemia in patients receiving home total parenteral nutrition. JPEN J Parenter Enteral Nutr. 2002;26:114-119.
