Gonzales, Prince Rupee D.

BN3-A
Nursing Update 01/18/2021

Premixed vs Compounded Parenteral Nutrition: Effects of Total Parenteral Nutrition Shortage on

Clinical Practice

Abstract

Purpose of review: Drug shortages continue to impact our patients with intestinal failure and
their ability to receive nutrition. ASPEN guidelines address the management of certain shortages
in compounded total parenteral nutrition (TPN); however, some institutions have utilized
premixed total parenteral nutrition (pTPN) in place of TPN.

Recent findings: Premixed TPN appears to be as safe, if not safer, as compounded TPN when
comparing the risk of bloodstream infection. However, there is an increased use of supplemental
electrolytes to meet patient needs. Cost-effectiveness depends on multiple factors and should be
evaluated by each institution when considering the use of TPN. In light of the published
information on the use of pTPN compared to TPN, institutions and nutrition clinicians should
consider their current practice and opportunities to consider when pTPN may be beneficial for
their patients, not only from a safety perspective, but also considering cost savings. However,
close monitoring and individual patient needs should be considered as these formulas may not
meet all patient nutritional and electrolyte needs.

Reference:

BR;, B. (n.d.). Premixed vs Compounded Parenteral Nutrition: Effects of Total Parenteral

Nutrition Shortage on Clinical Practice. Retrieved January 18, 2021, from
https://pubmed.ncbi.nlm.nih.gov/31691201/
Reflection:
Shortages of compounded total parenteral nutrition or commonly known as TPN continue
to impact patients with intestinal failure and their ability to receive nutrition. In line with this,
some institutions utilized premixed total parenteral nutrition to supply the nutritional needs of the
patients. According to the findings, premixed total parenteral nutrition (pTPN) appears to be safe
just like the compounded TPN. However, the use of pTPN may not meet all the nutritional and
electrolyte needs of the patient.

Premixed total parenteral nutrition is a good substitute when TPN is not available
however nurses should be observant and should monitor the patients closely since not all
nutritional needs can be provided by pTPN. As a student nurse, this topic is helpful since it
provides me supplemental information regarding parenteral administration and nutrition. I should
be mindful when assisting in TPN feedings and should keep a close watch on my patients to see
if they are exhibiting signs and symptoms of TPN complications.