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40
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Hyperlink
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URL
https://doi.org/10.5863/1551-6776-27.6.524
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Title
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Evaluation of Inpatient Starter Parenteral Nutrition Use in the Neonatal Intensive Care Unit
Creator
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Kayla Novick
M Petrea Cober
Date
A point or period of time associated with an event in the lifecycle of the resource
2022
Description
An account of the resource
Objective: Parenteral nutrition (PN) promotes growth and development in neonatal patients while avoiding malnutrition and metabolic derangements. Very low birth weight premature infants should be started on PN within 24 to 48 hours after birth. The objective of this study was to compare starter PN solution use at a freestanding children's hospital health care system before and after the development of a standard starter PN protocol. The secondary objective was to evaluate the estimated annual cost savings due to a standard protocol.
Methods: A single-center, retrospective chart review of neonates who received starter PN in the NICU setting from October through December 2020 after the implementation of the protocol was conducted. The protocol was developed based on usage trends from October through December 2019. Starter PN use was compared within neonatology groups before and after the development of a standardized protocol.
Results: In 2019, 108 neonates weighing <1.8 kg were admitted to the NICUs, while 101 were admitted in 2020. However, 170 neonates received starter PN in 2019, while only 94 neonates received starter PN in 2020. Overall, protocol adherence was 88%. The mean gestational age for patients who were initiated on starter PN decreased from 31 weeks in the pre-protocol group to 28 weeks in the post-protocol group (p < 0.001). The mean birth weight pre-protocol was 1.61 kg, which decreased to a mean of 1.23 kg in the post-protocol group (p < 0.001). The estimated annual cost savings for the inpatient pharmacy department was approximately $13,000 with the initiation of a standard protocol.
Conclusions: The implementation of a standard starter PN protocol decreased usage and variability in NICU practice and aligned more with the American Society for Parenteral and Enteral Nutrition recommendations.
Source
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J Pediatr Pharmacol Ther
. 2022;27(6):524-528. doi: 10.5863/1551-6776-27.6.524. Epub 2022 Aug 19.
Language
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English
2022
Infant
Intensive Care Units
Neonatal
neonatology
parenteral nutrition
Premature
-
Text
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URL Address
<a href="http://doi.org/10.1177/0884533614539177" target="_blank" rel="noreferrer noopener">http://doi.org/10.1177/0884533614539177</a>
Rights
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Pages
636-638
Issue
5
Volume
29
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Title
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Efficacy and Safety of Using L-cysteine as a Catheter-Clearing Agent for Nonthrombotic Occlusions of Central Venous Catheters in Children
Publisher
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Nutrition in Clinical Practice
Date
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2014
2014-10
Subject
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alteplase; catheter obstruction; catheters; central venous; ethanol; hydrochloric-acid; L-cysteine; Nutrition & Dietetics; occlusion; parenteral nutrition; tissue-plasminogen activator; trial
Creator
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Pai V B; Plogsted S
Description
An account of the resource
Critically ill pediatric patients, especially in the intensive care unit, receive multiple medications and have a higher risk of central venous catheter (CVC) occlusion. If an occlusion occurs immediately after the administration of multiple medications or incompatible medications, either an acidic solution such as 0.1 N hydrochloric acid (HCl) or a basic solution of 1 mEq/mL sodium bicarbonate or 0.1 N sodium hydroxide can be used. However, compounding and storing of 0.1 N HCl has become more complex due to USP <797> guidelines for sterile compounding, and an alternative is needed. We report a series of cases in which L-cysteine was used instead of HCl to clear CVCs occluded due to administration of multiple medications. L-cysteine is a commercially available, sterile solution with a pH of 1-2.5. CVC occlusion was resolved in 10 of the 16 episodes in 13 patients. Two of the 16 occlusions were phenytoin related and would not have responded. An L-cysteine dose of 50 mg was used during 10 of the 16 episodes, 100 mg during 5 episodes, and 25 mg during 1 episode. A correlation between catheter clearance and dose was not observed. Occlusion resolution due to L-cysteine was not correlated to the prior use of tissue plasminogen activator. Metabolic acidosis, adverse effects, or damage to the catheters due to L-cysteine were not observed. On the basis of this limited experience, we propose L-cysteine as an effective alternative to 0.1 N HCl for clearing CVC occlusions caused by drugs with an acidic pKa.
Identifier
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<a href="http://doi.org/10.1177/0884533614539177" target="_blank" rel="noreferrer noopener">10.1177/0884533614539177</a>
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Journal Article
2014
alteplase
catheter obstruction
Catheters
Central Venous
ETHANOL
hydrochloric-acid
Journal Article
L-cysteine
Nutrition & Dietetics
Nutrition in Clinical Practice
occlusion
Pai V B
parenteral nutrition
Plogsted S
tissue-plasminogen activator
trial
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1177/0884533616662994" target="_blank" rel="noreferrer noopener">http://doi.org/10.1177/0884533616662994</a>
Pages
642–646
Issue
5
Volume
31
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Repackaging of Intravenous Fat Emulsions: A Clinical Conundrum.
Publisher
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Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
Date
A point or period of time associated with an event in the lifecycle of the resource
2016
2016-10
Subject
The topic of the resource
Drug Packaging – Methods; Drug Packaging/*methods; Fat Emulsions; Humans; Infant; Intravenous – Administration and Dosage; intravenous fat emulsions; Intravenous/*administration & dosage; Medication Errors – Prevention and Control; Medication Errors/*prevention & control; neonates; Newborn; parenteral nutrition; Parenteral Nutrition – Methods; parenteral nutrition solutions; Parenteral Nutrition/*methods; pediatrics
Creator
An entity primarily responsible for making the resource
Cober M Petrea
Description
An account of the resource
To accommodate small fluid volumes, repackaging of intravenous fat emulsions (IVFEs) is frequently performed in institutions providing parenteral nutrition to neonates and smaller pediatric patients. However, some consider this an unsafe practice. Concerns for potential administration errors leading to an overdose of IVFEs are weighed against the potential for microbial contamination from the repackaging process. The clinician providing pediatric nutrition support should tailor repackaging practices to ensure patient safety and quality. This discussion aims to describe the strengths and limitations surrounding IVFE repackaging to provide guidance regarding the practice.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1177/0884533616662994" target="_blank" rel="noreferrer noopener">10.1177/0884533616662994</a>
Rights
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
2016
Cober M Petrea
Department of Pharmaceutical Sciences
Department of Pharmacy Practice
Drug Packaging – Methods
Drug Packaging/*methods
Fat Emulsions
Humans
Infant
Intravenous – Administration and Dosage
intravenous fat emulsions
Intravenous/*administration & dosage
Medication Errors – Prevention and Control
Medication Errors/*prevention & control
NEOMED College of Pharmacy
neonates
Newborn
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
parenteral nutrition
Parenteral Nutrition – Methods
parenteral nutrition solutions
Parenteral Nutrition/*methods
Pediatrics